In addition, everyone develops a very uncomfortable and irresistible urge to breathe following prolonged breath holding. These include breathing through devices with increased resistance and chest wall restriction produced by elastic wrapping. There are a number of ways to produce uncomfortable respiratory sensations in normal people. None of these measurements actually aids in the detection of dyspnea, but may be of some value in explaining or quantifying dyspnea in a patient.ĭyspnea is a difficult subject to study in the laboratory because it is detected and measured only by subjective reporting in conscious people. Occasionally patients require more sophisticated testing, including exercise testing with gas exchange measurements, measurements of pulmonary compliance, and measurements of respiratory muscle strength and respiratory neurologic drive. Arterial blood gases are, therefore, most useful for quantifying the severity of gas exchange abnormalities in patients with established pulmonary dysfunction.ĭepending on the findings obtained during the history and physical examination, laboratory testing of cardiac function and neuromuscular function may be useful in making a diagnosis. There is not a good correlation between the severity of hypoxemia and the severity of dyspnea. Arterial blood gas studies are generally performed in dyspneic patients, but are of limited usefulness in evaluating dyspnea. More sophisticated and expensive tests are frequently unnecessary. The vital capacity and forced expiratory volume in 1 second (FEV 1) obtained from simple spirometry usually correlate well with the sensation of dyspnea in most patients with lung disease. Pulmonary function tests are useful in the detection of obstructive and restrictive diseases of the lung and chest wall. The laboratory is of no use in the detection of dyspnea, but may be of great value in the differential diagnosis and in quantifying the severity of the underlying disorder. The chest radiograph may also be abnormal in patients with obstructive pulmonary disease, but the chest film is neither sensitive nor specific for the detection of airflow obstruction major abnormalities on the chest film are seen only in patients with far advanced obstructive pulmonary disease. Characteristic roentgenographic findings occur in patients with congestive heart failure, pneumonia, and pulmonary fibrosis. Cardiac, pulmonary, and neuromuscular examinations should receive particular attention in patients with dyspnea.Ī chest radiograph is frequently helpful in evaluating patients with dyspnea. The accessory muscles of respiration may be used, and supraclavicular and intercostal retractions may be seen. Dyspneic patients frequently breathe rapidly and shallowly. In spite of this, in most patients a very good association exists between the severity of the underlying disease and the complaint expressed by the patient.Īlthough no physical findings directly relate to the complaint of dyspnea, several things may be seen in dyspneic patients. Because dyspnea, like pain, is a subjective symptom, it is frequently influenced by the state of mind of the patient. Dyspnea may be the limiting symptom and may be responsible for economic and social disabilities. The quantification of dyspnea is also important in judging the severity and prognosis of the underlying disease.
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