Dyspnoea

Dyspnoea or shortness of breath is defined by the American Thoracic Society as a subjective awareness of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.

Breathlessness is a commonly reported respiratory symptom. The causes of dyspnoea are manifold and range from benign to serious diseases of the airway, lungs or heart. Treating dyspnoea is important or else it can lead to complications such as decreased levels of consciousness, temporary or permanent cognitive impair. It can be a sign of onset or aggravation of other health problems. The pathophysiology of dyspnoea is complex and not fully understood.

Identifying the exact cause of dyspnoea in any given case may require significant investigation and can be a lengthy process.

Some basic tests to diagnose the cause of breathlessness are:

• Chest X-ray- It’s a radiology test that can help see signs of conditions such as pneumonia or other lung and heart disorders.
• Oxygen test- Also called pulse oximetry is used to measure oxygen levels in blood.
• Electrocardiography (ECG) - It helps to know if blood flow to heart is impaired.
• Lung Function Test- Spirometry and plethysmography are the common tests used to identify patients with obstructive and restrictive lung disorders.
• Blood tests- These help to know whether conditions such as anemia or heart failure are causes of breathlessness.

CAUSES OF DYSPNOEA

Physiological causes of dyspnoea include:

• Intense or prolonged exercise
• Travelling to a high altitude
• Major temperature changes

Pathological causes and health problems leading to dyspnoea are:

• Asthma
• Heart failure
• Chronic obstructive pulmonary disease(COPD)
• Interstitial lung disease
• Pneumonia
• Psychogenic problems that are usually linked to anxiety.

Further causes of acute dyspnoea where shortness of breath starts suddenly are:

• Asthma
• Anxiety
• Pneumonia
• Choking on or inhaling something
• Allergic reactions
• Anemia
• Serious loss of blood causing anemia
• Exposure to alarming carbon dioxide levels
• Heart failure
• Hypotension or low blood pressure
• Collapsed lung
• Hiatal hernia
• Pulmonary embolism i.e a blood clot in an artery to the lung

Causes of chronic dyspnoea where a person experiences shortness of breath for over a month are:

• Asthma
• COPD
• Obesity
• Heart problems such as heart failure, heart rhythm problems, cardiomyopathy i.e a range of diseases affecting the heart muscle and pericarditis when the tissue surrounding the heart becomes inflamed.
• Lung diseases such as Interstitial pulmonary fibrosis that causes scarring of the lung tissue, croup, traumatic lung injury, lung cancer, tuberculosis, pleurisy i.e inflammation in the tissues surrounding the lungs, pulmonary edema i.e too much fluid collected in the lungs, pulmonary hypertension i.e high blood pressure in the arteries to the lungs, sarcoidosis which causes clusters of inflammatory cells to grow in the lungs.

SIGNS AND SYMPTOMS OF DYSPNOEA

Dyspnoea is not a single respiratory sensation. Other aspects such as chest tightness, sense of work/effort and respiratory discomfort mainly contribute to the sensation of dyspnoea.

Signs that indicate a person to be having dyspnoea include:

• Shortness of breath
• Feeling suffocated
• Labored breathing
• Tightness in the chest
• Rapid and shallow breathing
• Heart palpitations
• Wheezing
• Coughing

GENERAL MANAGEMENT

Following measures can be taken to improve the overall health of patients with dyspnoea:

• Quit smoking
• Avoid passive smoking
• Avoiding environmental triggers such as wood smoke, dust and chemical fumes
• Avoid exposure to allergens such as pollen or molds that trigger episodes of dyspnoea.
• Losing weight that reduces stress on heart and lungs.
• Regular exercise that strengthens the cardiovascular and pulmonary system.
• Take time to adjust to higher altitudes and reduce exercise levels at altitude above 5000 feet.
• Dyspnoea due to COPD can be helped with special breathing techniques such as pursed-lip breathing and respiratory muscle strengthening exercises.
• Many dyspnoeic patients find a gentle stream of cool air around the head and face helps improve their symptoms.

HOMEOPATHIC MANAGEMENT

Homeopathy provides best treatment option for dyspnoea. It is non expensive mode of treatment that helps to relieve not only an acute episode of dyspnoea but constitutional homeopathic medicine can eliminate the root cause of dyspnoea and prevent further occurrence of dyspnoeic episodes. However in emergency cases and if someone is already on allopathic medications for dyspnoea, sudden stopping of treatment is not advised. One should continue using conventional treatment alongside homeopathic treatment. Homeopathic medicine can eventually reduce the dependency on allopathic medicine and can even wean the patient off them.

Apart from this it is seen that patients on prolonged allopathic treatment for dyspnoea which is primarily based on use of steroids, antibiotics or habit forming drugs such as opiates and anti anxiety medicines show various side effects. On the other hand homeopathic medicines prescribed by an efficient physician are completely safe and don’t cause any side effects.

The best homeopathic medicine for dyspnoea is the one most similar to the disease manifestation in any given case. For this the homeopathic physician takes a complete case record of the patient to elicit the cause and effects of dyspnoea on both mental and physical sphere.

Various commonly prescribed homeopathic medicines for dyspnoea are:

Antimonium Tartaricum- It is used in the treatment of respiratory illness with rattling of mucus but little or no expectoration. There is much drowsiness, debility and sweat as the characteristics of this medicine

Arsenicum Album- It is used in dyspnoea especially due to asthma. Cough is worse after midnight and on lying on back. There is burning in chest. Expectoration is scanty and frothy. Along with this there is great exhaustion after least exertion, burning pains, irritable weakness and frequent thirst for small quantity of water

Blatta Orientalis- It is used in dyspnoea when associated with bronchitis. There is much pus like mucus. It acts best in obese patients.

Crataegus- It is a heart tonic and acts on muscles of heart. There is extreme dyspnoea on least exertion. Pulse is accelerated, irregular, feeble and intermittent. There is insomnia, anemia, oedema and cutaneous chilliness with blueness of fingers and toes all aggravated by exertion or excitement.

Medorrhinum-  Medorrhinum is suited for asthma in children particularly where it is associated with eczema. Dyspnoea is better when the child kneels on the bed curled up with the chest touching the knees. Asthma is aggravated in wet weather and becomes better at the seaside.

Natrum Sulphuricum- It is indicated in asthma in children and in cases with delayed resolution of pneumonia. Cough is with thick and greenish expectoration. It is best suited when complaints are due to living in damp houses, cellars or basements and are aggravated in rainy weather or water in any form. Such a person cannot even eat plants growing near water nor fish.

Tuberculinum- Tuberculinum is suitable in patients with dyspnoea as it strengthens the immune system and prevents recurrent cold and chest infections which are likely to cause dyspnoeic attacks.