DYSPNOEA

Dyspnoea

Introduction:-

  The term dyspnoea refers to sudden and some shortness of breath or difficulty in breathing. Breathlessness may be normal after exercise or exertion. They usually resolve itself. Breathlessness that comes on suddenly and unexpectidy may be a warning sigh of underlined disease.

Cause:-

Bronchial asthma

Chronic asthma

Emphysema

Bronchieteatis

NOTE:-

COPD (Chronic obstructive pulmonary disease) are commonly used clinical term for a group of pathological condition in which there is chronic, partial or complete obstruction to the airflow at any level from trachea to the smallest air ways results in functional disability of lungs. The following Four entities are included in COPD.

1. Chronic bronchitis:-

    It is a common condition defined clinically as persistent cough with expectoration on most days for at least 3 months of the year for 2 or more consecutive years. The cough is caused by over secretion of mucus.

Cause-

Cigarette smoking

Atmospheric pollution

Occupational Disease

Family and genetic factors

Clinical features:-

i. Paroxysms of cough

ii.Dyspnoea

iii. Wheezing respiration

iv. It typically last for a few minutes to hours.

2. Emphysema:-

   It is defined as combination of permanent delatation of air base distal t the terminal bronchioles and the distructions of the walls of dilated air base (Alveolei)

Thus, Emphysema is defined morphologically, while chronic bronchitis is defined clinically.

Etiology-

Smoking

Air pollution

Occupational disease

Family and genetic factors

Clinical features-

  The age at time of diagnosis is often a decate later (about 60 years). Then the age for the predominent bronchitis(about 50 years).

It is a common condition defined clinically as persistent cough with expectoration on most days for at least 3 months of the years. The cough is caused by over secretion of mucus.

3. Bronchial asthma:-

   Asthma is a disease of air base ie characterized by increased responsiveness of the tracheobronchial tree to a variety of stimulus resulting in wide spread spasmodic narrowing of air passage which may be relieved spontaneously or by air therapy. It is manifest as paroxysms of dyspnoea cough and wheezing.

Etio-pathogenesis:-

  The two main types are -

1. Atopic, allergic asthma or Extrinsic asthma

2. Intrinsic asthma

3. Mixed type

1. Extrinsic asthma:-

  It is usually begins in childhood or early adulthood life. Hypersensitivity to various extrinsic antigenic substance or allergens is usually present in this case. Allergens eg- house dust, pollen grains, animal danders (fur, scales etc) etc.

2. Intrinsic asthma:-

   This type of asthma develops laters in adult life with or without family history of adult. Most of these patients develops symptoms after upper respiratory tract infection by virus. Associated with nasal palyp or chronic bronchitis is possible.

3. Mixed type:-

    Many patients do not clearly fit into either of the above 2 categories. Those patients who develops asthma in early life have strong allergic component, while those who developed the disease later tend to be non-allergic.

Clinical feature-

Paroxysms of dysnoea

Cough

Wheezing

         Most attack last for a few minute to hours. When attack occur continuously, it result in more serious condition called "status asthmaticus".

4. Bronchiectasis :-

   It is defined as abnormal irreversible dilation of the bronchi and bronchioles(greater than 2mm) in diameter, developing secondary to the inflammatory weakening if the bronchial walls. The most characteristic clinical manifestation is persistent cough with expectorations of copious amount of foul smelling, purulent sputum.

Clinical features-

Chronic cough with foul smelling sputum production, hemoptysis (bloody sputum) and recurrent pneumonia sinusitis may be present.