DYSPNEA

Dyspnea comes from the Latin word dyspnoea which means shortness of breath. It is a sensation of difficult or uncomfortable breathing or a feeling of not getting enough air.

What Causes Shortness of Breath? Shortness of breath has many different causes:

A blockage of the air passages in your nose, mouth, or throat may lead to difficulty breathing. Heart disease can cause breathlessness if your heart is unable to pump enough blood to supply oxygen to your body. If your brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur. Lung disease can cause breathlessness. Sometimes emotional distress, such as anxiety, can lead to difficulty breathing.

The following problems may cause breathing difficulty: Problems with the lungs:

Blood clot in the arteries of the lungs (pulmonary embolism) Bronchiolitis Chronic obstructive pulmonary disease (COPD), asthma, and other chronic lung problems Pneumonia Pulmonary hypertension

Problems with the airways leading to the lungs:

Choking on something stuck in the airways Croup Epiglottitis

Problems with the heart:

Heart attack or angina Heart defects from birth (congenital heart disease) Heart failure Heart rhythm disturbances (arrhythmias)

Other problems:

Allergies (such as to mold, dander, or pollen) Climbing to high altitudes where there is less oxygen in the air Compression of the chest wall Dust in the environment Hiatial hernia Obesity Panic attacks

Population at risk Risk factors for dyspnea are associated with the diseases and conditions in which dyspnea occurs. Clinical risk factors include having chronic asthma, COPD, cardiovascular disease (e.g., CHF, coronary artery disease [CAD]), and consistent exposure to toxic irritants such as tobacco smoke and certain industrial toxins. Individuals with anemia, anxiety and panic disorders, sedentary lifestyle, and obesity are at greater risk of developing dyspnea than those without these conditions. Asthma occurs with equal frequency among men and women. There is a bimodal distribution of incidence, with the first peak occurring in childhood and adolescence. In childhood asthma, the male to female ratio is 2:1, and after puberty this reverses, with higher prevalence in females. The second peak occurs beginning from middle age onwards, usually in response to exposure to workplace and environmental pollutants. Adult-onset asthma in individuals older than age 40 is also predominately female (Morris). Individuals at risk for pulmonary embolism include those with cancer, immobilization or prolonged bed rest, deep vein thrombosis (DVT), recent pregnancy recent surgery, those taking estrogen-containing drugs, and those with a family history of the condition (Lechtzin). Cigarette smokers have a greater risk of developing COPD and OLD than nonsmokers. Other risk factors for OLD include inhaling organic and inorganic dusts, irritant gases, and toxic fumes that adversely affect both the upper and lower airways. Anxiety and panic disorders are more common in women than men by 2:1 (Plewa). At high altitudes, individuals with CAD, asthma, anemia (especially sickle cell disease), and COPD are at greater risk of experiencing dyspnea as a symptom than those without these conditions (Kale). Incidence and Prevelance: The exact incidence of dyspnea cannot be estimated because of the broad range of diseaserelated causes in which it may occur. Dyspnea is often recorded as a symptom of an underlying disease rather than as a separate disease. Incidence of common causes of dyspnea is shown below. Asthma is a common condition that affects 22 million individuals in the US, occurring in

about 5% to 10% of the population and accounting for more than 1.8 million emergency department visits annually (Morris). Panic disorders are present in 5% to 40% of individuals with asthma, and occur with a prevalence of 1% to 5% of all individuals in the US (Plewa). About 12 million adults over age 25 have been diagnosed with COPD; of these approximately 9.2 million individuals have chronic bronchitis, 2 million have emphysema and 0.9 million have both conditions (Doherty). It is estimated that at least other 12 million individuals have undiagnosed COPD. Occupational lung disease is a leading cause of work-related health problems in the US, but the actual incidence is difficult to determine because of lack of reporting, low recognition of signs and symptoms associated with substance exposure, and poor understanding of the disease and of the guidelines for diagnosis. About 19.8% of US adults smoke tobacco; death from tobacco smoking occurs 13 to 14 years earlier than in non-smokers (CDC Tobacco Fact Sheet). Heart disease, including CHF, CAD, and myocardial infarction, is the leading cause of death in men and women in Native American, Alaskan natives, blacks, whites, and Hispanic populations (CDC Heart Disease Fact Sheet). Incidence of HAPE is 0.01% to 0.1% in the general population and as high as 20% to 33% in climbers (Kale) Mangament: How Is Shortness of Breath Treated? The type of treatment depends on the underlying cause. If you are diagnosed with heart failure, you may treated with medications such as fluid pills (diuretics), angiotensinconverting enzyme inhibitors, digoxin, and beta-blockers. If asthma or chronic lund disease is the cause, you may be treated with medications that reduce spasm or inflammation of te airways or with oxygen. For infection, you may be prescribed an antibiotic. What Can I Do to Take Care of Myself? Quit smoking. Cessation of smoking will help to relieve some of your symptoms and to reduce your risk for lung cancer. Avoid exposure to allergens, dust, and toxic substances. If you are asthmatic, avoid exposure to the allergens that causes shortness of breath. Avoid becoming overweight and exercise regularly. Always consult your physician befroe beginning a weight loss or exercise program. If you have a heart failure, take your medications regularly, avoid salt intake, and weigh yourself for daily to monitor fluid status.

Learn about your medical condition. Talk with your healthcare provider to learn about methods to alleviate or resolve shortness of breath. Develop an action plan for worsening symptoms.

Suggestions to decrease Dyspnea

Find a position that is comfortable for you: Sit in a chair. Lean forward with your arms and upper body supported on a table. Stand upright. Brace yourself against the wall and lean forward a little bit. Lay on your back with your head up.

Focus on your breathing pattern: Take slow breaths. When your breathe out, put your lips together, like slowly blowing out a candle. PURSED LIP BREATHING

Use relaxatin techniques: Imagery Focus your thoughts on pleasant things, such as being wuth a speacial person, or in your favorite place, or doing a relaxing activity. Muscle relaxation Slowly contract and relax each muscle group, one at a time.

Use a fan to blow air on your face. Plan your activities: If your are doing an activity and become short of breath, stop the activity and rest. Rest before and between doing activities that take extra energy.

Nursing Diagnosis

Resources: 1. American Thoracic Society. Consensus statement on dyspnea. Available at: http://www.olivija.com/dyspnea./Accessed June 13, 2003 2. American Acadeny of Family Physicians. Diagnostic eveluation of dyspnea. Available at: http:/www.aafp.org/afp/980215ap/morgan.html. Accessed June 13, 2003 3. http://www.mdguidelines.com/dyspnea