Introduction
What is dyspnea?
Dyspnea is a term used for shortness of breath. It is characterised by difficulty breathing and the feeling of asphyxia, and breathlessness.
Causes of dyspnea
It may result from respiratory or cardiac diseases. In the case of respiratory failure, the lungs fail to inhale and exhale the air properly, leading to dyspnea. Respiratory system diseases include pneumonia, chronic obstructive pulmonary disease(COPD), and asthma. In cardiac diseases, the heart fails to meet the blood (and resultantly of oxygen) demands of the body’s tissues resulting in dyspnea. The cardiac issues include congestive heart failure, left heart failure etc.
Types of dyspnea
Depending on the causes of dyspnea, it is classified into various categories. These are:
Respiratory dyspnea
Cardiac dyspnea
Psychogenic dyspnea
Depending on the precipitating factors, dyspnea has two types.
• Exertional dyspnea
• Dyspnea at rest
Exertional dyspnea
Here, the precipitating factor is exertion, or, in another case, dyspnea worsens by labour(exertion).
Dyspnea at rest
This is the worst form of dyspnea in which no exertion is needed; dyspnea occurs even at rest.
History questions differ in patients depending on the type of shortness of breath they are suffering from.
Questions to be asked of patients suffering from shortness of breath on exertion
1. What is the duration of dyspnea(shortness of breath)?
2. Ask the patient how much exertion causes shortness of breath.
3. How much distance can the patient walk without becoming short of breath?
4. Is shortness of breath progressive?
5. Ask about paroxysmal nocturnal dyspnea
6. Ask about the aggravating and relieving factors.
7. Ask the patient about the associated symptoms
What is the duration of dyspnea(shortness of breath)?
Ask the patient how long the ng they have been suffering from dyspnea. The duration may vary according to the type of diseases. It also gives an estimation of how old the disease is, whether it is acute or has become chronic?
Ask the patient how much exertion causes shortness of breath?
Exertion may be of different types. It can be mild or severe. So it is important to ask how much exertion results in shortness of breath. Does it happens on climbing the stairs? If yes shortness of breath occurs on severe exertion. Does it occurs on walking at a normal place?
How much distance can the patient walk without becoming short of breath?
Is shortness of breath progressive?
It is also essential to ask the patient if shortages of breath have been exaggerated as time passes. Has the magnitude of exertion precipitating shortness of breath decreased since the dyspnea started? It gives an idea about the underlying cause of the dyspnea as dyspnea due to chronic lung disease, and heart failure is usually progressive, i. e increased as time passes.
Does patient arises due to shortness of breath at night?
Sudden bouts of breathlessness which awaken the patient from sleep at night are known as paroxysmal nocturnal dyspnea. Ask the patient if they awaken at night due to shortness of breath. It also helps the doctor diagnose the disease because paroxysmal nocturnal dyspnea commonly occurs in left heart failure.
Aggravating and relieving factors
Ask the patient if dyspnea worsens on lying flat. If present, it is called orthopnea. It is also a common feature of left heart failure.
Ask the patient about the associated symptoms
Associated symptoms with shortness of breath also help diagnose the disease. These symptoms include:
• Cough
• Blood in cough
• Sputum
• Blood in sputum
• Sweating
• Chest pain
• Increased heartbeat
• Fever
• Vomiting
dyspnea at rest
If shortness of breath occurs without exertion, it is called dyspnea at rest.
The dyspnea may occur in episodes. The reason may be bronchospasm due to bronchial asthma.
Questions to be asked of a patient while taking a history of a patient suffering from Dyspnea at rest
1. What was the age of onset?
2. Is there any wheezing?
3. Ask about frequency of attacks
4. What is the severity of the attacks?
5. What is the estimated duration of each attack?
6. Ask about any changes in attacks
7. History of the skin or nasal allergy
8. Any prior treatment
9. Ask the patient if he/she requires regular treatment to remain symptom-free.
What was the age of onset?
It helps to diagnose the disease the patient is suffering from.
Is there any wheezing?
Ask the patient if there are any whistling sounds. If the patient is not able to tell, take the help of attendant of the patient.
Ask about frequency of attacks
Ask the patient how many episodes of dyspnea occur each day. What is the severity of the attacks? Mild or severe?
Ask about the duration of attacks
Ask the patient once the dyspnea started and for how long it continued. What is the estimated duration of each attack?
Ask about any change in attacks
Ask the patient if there is any change in the frequency, severity and duration of attacks. Has the frequency increased with time? So the attacks occur more frequently now? Is the severity of attacks increasing day by day? Do the attacks remain for a longer period now?
History of the skin or nasal allergy
Ask the patient if they he/she has any skin or nasal allergies. Allergy can also be a cause of shortness of breath. Also, ask about a family history of such allergies.
Any prior treatment
Ask the patient if he/she requires regular treatment to remain symptom-free.
Conclusion
So these are all the routine questions that a doctor must ask of a patient while taking the history of a patient suffering from shortness of breath (dyspnea).
Note: Don’t forget to ask about the patient’s personal history, past history and systemic inquiry etc.
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