Difficulty Exhaling : Causes, Symptoms, Diagnosis & Treatment

• Causes Of Difficulty Exhaling
• Bronchial Asthma
• Obstructive Bronchitis
• Other Obstructive Diseases
• Chronic Pathology Of The Lungs
• Occupational Diseases
• Complications Of Pharmacotherapy
• Survey
• Symptomatic Therapy

Difficulty in exhalation (expiratory dyspnea) is a violation of the respiratory function with a significant lengthening of the exhalation, accompanied by a subjective feeling of fullness, tightness in the chest. The symptom is pathognomonic for bronchial asthma. Expiratory dyspnea is also observed in bronchial obstructive diseases, chronic lung diseases, and some tumors. To identify the causes of difficult exhalation, x-rays, spirography, bronchoscopy, and laboratory tests are performed. Bronchodilators, glucocorticosteroids, antihistamines, expectorants are used to relieve symptoms.

Causes of difficulty exhaling

Shortness of breath of the expiratory type is caused by a violation of the patency of the bronchial tree and is a symptom of an obstructive form of chronic respiratory failure. Blockage of the bronchus can develop both with organic pathologies of the respiratory tract, and with the ingress of a foreign body. Difficult exhalation also occurs in the second stage of asphyxia, when compensatory reactions are exhausted and the respiratory center in the medulla oblongata is depressed. More rare causes of shortness of breath: bronchospasm in Mendelssohn's syndrome, tracheal tumors located near its bifurcation.

Bronchial asthma

The disease is characterized by a sudden difficulty in exhaling after contact with provoking substances. A few minutes before the attack, a sore throat, nasal congestion, and itchy skin are felt. Then there is a sharp feeling of tightness in the chest, an acute shortage of air and the inability to make normal respiratory movements. Inhalation is short, convulsive, exhalation is significantly lengthened. When exhaling air, whistling sounds and wheezing are heard. To alleviate the condition, patients sit down, dangling their legs, lean their hands on their knees or lean on the bed.

During an attack, the patient's appearance is typical: his eyes are wide open, his face seems puffy, a blue nasolabial triangle is noticeable. When you inhale, the neck veins swell. Due to the difficulty of exhalation, active movements of the chest, tension of the abdominal press are noticeable. With mixed bronchial asthma, shortness of breath is provoked not only by contact with allergens, but also by stress, the action of cold air. Attacks of labored exhalation occurring exclusively at work are pathognomonic for occupational asthma.

Prolonged paroxysms of difficulty in breathing, which are not stopped by the usual drugs, are observed in status asthmaticus. A person is constantly in a forced position (orthopnea), there is a sharp cyanosis of the nasolabial triangle, blue fingertips. Patients are restless, convulsively inhale the air, some patients experience fear of imminent death. With the progression of respiratory failure, breaths become more and more rare, the person loses consciousness. If emergency medical care is not provided, a fatal outcome is possible.

Obstructive bronchitis

The disease is accompanied by bronchoconstriction, due to which there are constant respiratory disorders of varying severity. In acute obstructive bronchitis, expiratory dyspnea often occurs during a coughing fit. The phase of exhalation of air is significantly lengthened, patients complain of tightness in the chest, suffocation. The pulse becomes more frequent, cyanosis of the lips is possible. Similar attacks of shortness of breath occur throughout the entire period of illness - about 2-3 weeks. Difficulties in exhalation also indicate a complicated course of chronic bronchitis.

Shortness of breath with minimal physical exertion occurs with bronchitis of smokers, dusty bronchitis. At the same time, it is difficult exhalation that becomes one of the first symptoms and appears against the background of normal well-being. Young children are characterized by a special form of expiratory suffocation due to narrowing of the smallest bronchi - acute bronchiolitis, which complicates SARS, respiratory syncytial infection. The child has difficulty wheezing, swelling of the wings of the nose, cyanosis of the skin.

Other obstructive diseases

In addition to inflammation of the bronchial tree, other organic pathologies of the respiratory tract can cause difficulty exhaling. Violations in these diseases are formed gradually, imperceptibly, so patients do not go to doctors for a long time, which is fraught with a complicated course. The main link in the pathogenesis is changes in the structure of the bronchial wall, excessive growth of connective or scar tissue, causing bronchoconstriction. Expiratory dyspnea is accompanied by:

• COPD . At the onset of the disease, there is a slight shortness of breath during physical exertion, which is often overlooked. With the progression of morphological changes in the bronchi, shortness of breath with an extended exhalation develops at rest. During an attack, patients take a forced position, there is a strong cyanosis of the skin, and a paroxysmal excruciating cough is disturbing.
• Bronchiectasis . The appearance of difficult exhalation indicates the presence of respiratory failure. With bronchiectasis, the symptom can occur regardless of the time of day. Attacks of shortness of breath are long, in the terminal stages they are extremely difficult to stop with the help of bronchodilators. In addition to difficulty in exhaling, a strong cough develops with the release of copious purulent sputum, pain in the chest.
• Stenosis of the trachea and bronchi . Typical expiratory stridor is a noisy labored exhalation preceded by a short convulsive breath. The severity of difficulty in breathing depends on the cause of obstruction, the degree of stenosis. With narrowing of the trachea against the background of shortness of breath, short-term fainting is possible, associated with reflex effects on the nerve endings. Bronchoconstriction proceeds according to the type of recurrent bronchitis.
• Osteochondroplastic tracheobronchopathy . For a long time there were no complaints. With massive replacement of the walls of the respiratory tract with bone tissue, there is difficulty exhaling, noisy wheezing, patients experience a lack of air. Respiratory disorders are combined with dull pains in the chest cavity, sore throat. Gradually, shortness of breath increases, with a severe form of the disease, attacks of suffocation appear.
• Williams-Campbell Syndrome . With this congenital disease, respiratory disorders appear already in the first months of a child's life. Parents note that the baby becomes restless, breathing is noisy, stridor. Severe shortness of breath is evidenced by retraction of the intercostal spaces and supraclavicular fossae, cyanosis of the nasolabial triangle. The child refuses the breast or nipple, crying becomes quiet.

Chronic pathology of the lungs

Breathing difficulties are caused by both obstructive and restrictive mechanisms. Patients complain of the inability to inhale "full chest", prolonged expiration with whistling wheezing that can be heard at a distance. The symptom sometimes occurs with prolonged pneumonia and other chronic nonspecific lung diseases. The most common causes of shortness of breath are:

• Emphysema of the lungs . Difficulty in exhalation is initially noticed only during physical exertion, climbing several flights of stairs. Patients exhale air through tightly closed or folded lips, while strongly inflating their cheeks, “puffing”. Unlike other diseases, with emphysema, the skin has a healthy, pink color. A similar clinical picture is also found in the ventilation form of Macleod's syndrome.
• Pneumosclerosis . When replacing the lung parenchyma, shortness of breath occurs both during exercise and at rest. Expiration lengthening, feeling of shortage of air are noted, at long attacks the fear of death is expressed. Respiratory disorders are accompanied by diffuse cyanosis of the skin. Shortness of breath can occur at any time of the day, but painful suffocation is more often observed at night or in the early morning.
• Ascariasis of the lungs . Difficulty breathing with lengthening of the exhalation develops against the background of severe chest pain and general intoxication. Complaints of frequent and prolonged episodes of shortness of breath provoked by the allergic effect of helminths are typical. At the time of the attack, a dry cough with loud whistling wheezes begins. The patient sits on the bed, leans forward and rests his arms bent at the elbows on his knees.
• Alpha1 antitrypsin deficiency . Symptoms occur in young people with a predominant lesion of the lungs. Difficulties at first disturb when playing sports, running, climbing stairs above the 3rd floor. In the future, the lengthening of the exhalation manifests itself even at rest. During paroxysm, there is a feeling of lack of oxygen, the need for tension in the abdominal muscles for a full exhalation. Perioral cyanosis appears, wings of the nose swell.

Occupational diseases

Difficulties in exhalation are characteristic of byssinosis, which develops upon contact with the dust of spinning raw materials. Respiratory disorders become noticeable after breaks in work - holidays, weekends, which is called "Monday syndrome". Expiratory shortness of breath is accompanied by a feeling of heaviness and pressure in the chest, sore throat. The symptom also occurs with massive gasoline pneumonia. In such cases, expiratory lengthening is combined with cough, wheezing, and general symptoms of intoxication.

Complications of pharmacotherapy

Attacks of expiratory dyspnea occur with the so-called aspirin asthma. Symptoms appear immediately after taking the medication: patients experience painful convulsive breaths and a long whistling exhalation. A similar clinical picture is also observed in the bronchial type of allergy to salicylates, in this case, difficulties at the time of exhalation persist for 1-3 days after the use of medications. The symptom manifests itself with a severe degree of citrate intoxication - long episodes of respiratory disorders are characteristic, in the most difficult cases apnea occurs.

Survey

Patients with complaints of difficulty exhaling most often turn to a pulmonologist or general practitioner. Expiratory shortness of breath indicates serious disorders in the respiratory system, so a comprehensive laboratory and instrumental examination is necessary. During the diagnosis, the specialist evaluates the morphological features of the trachea, bronchi and lungs, and also examines the functional state of these organs. The most informative are:

• X-ray examination . To study the features of the anatomical structures of the chest cavity, a standard chest x-ray is performed in two projections - direct and lateral. The method helps to detect deformations of the bronchi and trachea, signs of sclerosis and emphysema. For better visualization of the respiratory tract and neighboring organs, CT is prescribed.
• Bronchoscopy . Endoscopic examination is aimed at studying the structure of the mucous membrane, identifying pathologically altered tissue areas and cicatricial stenosis. According to the indications, the method is supplemented with a forceps biopsy and bronchoalveolar lavage, followed by microscopic and bacteriological analysis of the washings.
• Spirometry . It is possible to establish the nature of difficulty in breathing by studying the main indicators - the forced expiratory volume in the first second, the functional vital capacity of the lungs, the Tiffno index. For differential diagnosis between bronchial asthma and other obstructive pulmonary diseases, a bronchodilatory test is recommended.
• Laboratory tests . The degree of respiratory insufficiency is determined according to blood tests - the level of hemoglobin saturation with oxygen, the concentration of carbon dioxide are determined. In the presence of a general infectious syndrome, a bacteriological blood test is indicated. To clarify the type of pathogen, serological reactions are carried out (RIF, ELISA, PCR).

To determine the etiological factor of bronchial obstruction in the remission phase, allergy tests are prescribed. If a congenital disease of the respiratory system is suspected, consultation of other specialists is required.

Spirometry

Symptomatic therapy

Difficulty exhaling often indicates organic diseases of the respiratory system, so qualified medical care is needed. If the disorder occurs for the first time and is severe, you need to urgently call an ambulance. Before the arrival of doctors, it is important for the patient to ensure peace and a sufficient supply of fresh air, transfer him to a semi-lying position, and limit contact with possible allergens. To reduce emotional stress, light herbal sedatives can be offered.

If an attack occurs in a patient with an established diagnosis of bronchial asthma, you should immediately take the previously prescribed bronchodilators in the form of an aerosol (beta-adrenergic agonists, anticholinergics, myotropic antispasmodics). In inflammatory diseases, expectorants can be used, in allergic conditions - antihistamines. In other cases, special medicines are allowed to be used only after examination by a doctor, taking into account his recommendations.