Lack Of Air : Causes, Symptoms, Diagnosis & Treatment

• Classification
• Causes Of Lack Of Air
• Pregnancy
• Pleurisy
• Lung Diseases
• Stenosis Of The Larynx
• Foreign Bodies Of The Respiratory Tract
• Pulmonary And Pleural Tumors
• Heart Diseases
• Emergency Conditions
• Chest And Lung Injuries
• Neurotic Disorders
• Survey
• Symptomatic Therapy

Lack of air (inspiratory dyspnea) is difficulty breathing while inhaling with a feeling of insufficient oxygen supply. May be accompanied by noisy, wheezing breathing. Occurs during pregnancy, diseases of the larynx, lungs, pleura, heart disease, emergency conditions, injuries, neuroses. To establish the causes of the disorder, chest x-ray, spirometry, ECG, laryngoscopy, and blood tests are prescribed. Prior to the diagnosis, to reduce severe shortness of breath, the patient is provided with rest, access to fresh air, and sedative herbal remedies are used.

Classification

When determining the degree of inspiratory dyspnea, the relationship between respiratory disorders and motor activity is taken into account. Normally, in a calm state, a person makes no more than 14-2 respiratory movements per minute, and the feeling of insufficient inhalation of air worries only after heavy exertion. There are 4 degrees of shortness of breath, indicating the likely presence of the disease:

• Light degree . Occurs when walking fast, climbing stairs or down a steep descent. Passes quickly on its own.
• Average degree . It is observed at a normal pace of walking. The patient is forced to slow down or take a break.
• Severe degree . Difficulty in breathing is observed when walking slowly at a distance of up to 10 m. The patient often stops to rest.
• Very severe degree . The lack of oxygen is felt in complete physical and emotional peace. The patient's activity is severely limited.

Causes of lack of air

Difficulty breathing in healthy people is caused by a mismatch between the amount of air inhaled and the need for oxygen. Such shortness of breath worries when doing hard work, during intense training, climbing mountains, in stressful situations. The appearance of a feeling of lack of oxygen contributes to the wearing of tight clothing, belts and corsets that prevent normal breathing. In older people, as a result of age-related changes in blood vessels and the heart, shortness of breath may occur with minimal exertion. The feeling of lack of air also manifests a number of conditions and diseases.

Pregnancy

Shortness of breath with a feeling of insufficient inspiration occurs mainly in the 2nd half of the gestational period. With an increase in the uterus, the diaphragm is pressed up, which limits the depth of breathing. The longer the gestation period, the more often there is a lack of oxygen even with calm walking and slight exertion. At the same time, the frequency of respiratory movements at rest increases to 22-25 breaths per minute. When shortness of breath, a pregnant woman is usually disturbed by slight dizziness, sometimes flickering of “flies” and darkening in the eyes.

The symptom is more often manifested and more pronounced in patients who bear a large fetus, multiple pregnancy, suffer from polyhydramnios. An aggravating factor is the syndrome of the inferior vena cava during pregnancy. With aorto-caval compression, in addition to shortness of breath, due to the limitation of the mobility of the diaphragm, the woman experiences difficulty in breathing and lack of air in the supine position. Respiratory distress is combined with sudden weakness, severe dizziness up to fainting.

Pleurisy

Increasing shortness of breath with difficulty breathing is a characteristic sign of inflammation of the pleura. Respiratory disorders are caused by intense pain during dry pleurisy, accumulation of fluid in the pleural cavity - with exudative, purulent, hemorrhagic process. Lack of air is the result of shallow, sparing breathing: in order to reduce acute stabbing or dull pulling pain over the affected areas, the patient limits the volume of respiratory movements. Often shortness of breath is accompanied by a painful dry cough, fever, chills.

lung diseases

With inflammatory and diffuse damage to the lung tissue, the feeling of lack of inhaled air is associated with the exclusion of part of the lung from the respiratory process, limiting its mobility and elasticity. Patients complain not of incomplete inspiration, weakness, fatigue, dizziness. With signs of pulmonary dyspnea, as a rule, proceed:

• Lobar pneumonia . Shortness of breath begins suddenly, simultaneously with a sharp rise in temperature to 39 ° C and above, severe headache, soreness of the affected part of the chest, weakness, dry, and later wet cough. Typical daily temperature fluctuations of 0.5-2 ° C, profuse sweating.
• Interstitial pneumonia . The feeling of "incomplete inspiration" appears gradually, first with exertion, later at rest. Often the lack of oxygen worries at night. Shortness of breath is accompanied by a dry cough, disrupts sleep, provokes fatigue in the daytime. In an acute process, changes in breathing resemble the symptoms of lobar pneumonia.
• Primary bronchopulmonary amyloidosis . Difficulty inhaling is pathognomonic for amyloid deposition in the wall of the trachea and large bronchi, while the patient's heavy wheezing can be heard from a distance. If the alveoli are damaged, lack of air with a dry cough disturbs at the slightest movement, conversation, at rest. At the same time, due to damage to the heart and blood vessels, there are pressing pains in the left chest, legs swell noticeably.
• Tuberculosis of the lungs . Lack of oxygen, causing shortness of breath, is characteristic of the primary tuberculous complex and the miliary process. The feeling of incomplete inspiration is manifested against the background of an unproductive cough, pain in the chest, subfebrile or high temperature, severe weakness and sweating. In addition, with disseminated tuberculosis, skin cyanosis is expressed.
• Zygomycosis of the lungs . Shortness of breath is preceded by a short period of severe intoxication with a temperature of 38 ° C, dry or unproductive cough, in which blood may be detected. Shortness of breath worries almost constantly, even at complete rest. Difficulty in inhalation is combined with a violation of exhalation. Later, severe chest pain joins, further restricting breathing.
• sclerotic processes . With diffuse pneumosclerosis, which developed as a result of post-radiation pneumonitis, pneumoconiosis, and other diffuse lung lesions, shortness of breath appears and increases gradually. In the terminal stages, the patient does not have enough air even at rest, due to oxygen deficiency, the skin becomes cyanotic, and the fingers are shaped like drumsticks (Hippocratic fingers).

Stenosis of the larynx

Most often, inhalation difficulties are caused by diseases in which, as a result of damage to the mucous membrane and vocal cords, obstacles are formed in the path of the movement of air masses. Shortness of breath of laryngeal origin is often characterized by a feeling of limited airflow into the airways, wheezing noisy breathing (stridor). The symptom is observed in the following pathological conditions:

• Acute stenosis of the larynx . Difficulty in inhaling, noisy breathing, hoarseness, hoarseness arise and grow extremely quickly. During inhalation, the intercostal spaces and the epigastric region are drawn in, the jugular fossae recede, and the wings of the nose swell. The patient shows anxiety, sometimes excitement, panic, feels the fear of death and, in order to facilitate the flow of air, leans on his hands. Breathing gradually becomes more frequent, becomes superficial, cyanosis of the face and nail phalanges is possible. Acute stenosis complicates the course of croup, false croup, damage during tracheal intubation, and other pathologies accompanied by laryngeal edema.
• chronic stenosis. A gradual increase in shortness of breath is characteristic of benign tumors and cancer of the larynx, laryngomalacia, other anomalies in the development of the organ, laringocele, neuropathic paresis, and thyroid lesions. Symptoms develop slowly. Shortness of breath against the background of a barking cough, a hoarse voice increases as the lumen of the larynx narrows, but the patient may not notice it for a long time due to gradual adaptation to hypoxia. In the later stages, lack of air disturbs at rest, intercostal muscles and abdominals are actively included in breathing. Lack of oxygen provokes memory impairment, sleep disturbances, absent-mindedness.

Foreign bodies of the respiratory tract

When foreign objects enter the respiratory tract, there is difficulty in breathing up to the complete impossibility of inhalation. Lack of air feels like suffocation. The patient shows anxiety, takes a forced position, breathes often and superficially (“sobs”). A distinctive feature is the suddenness of the development of the symptom after accidental inhalation of food, small objects. Almost immediately, a paroxysmal cough begins with lacrimation, profuse salivation, increased formation of nasal mucus. The face becomes purplish-bluish.

If a foreign body remains in the airways, not completely blocking their lumen, third-party sounds may occur during breathing. Balloting objects in the lumen of the trachea is accompanied by hissing, buzzing, whistling. For partial obstruction of the bronchus, a remotely audible whistle is characteristic. At the same time, the intensity of the cough decreases, it is possible to expectorate mucous sputum with particles of a foreign body. Shortness of breath becomes less frequent, but pain in the neck and chest increases. Subsequently, inflammatory processes join.

Pulmonary and pleural tumors

Features of inspiratory dyspnea in malignant neoplasia depend on the localization of the oncological process. However, in any case, respiratory disorders precede or supplement the specific symptoms of the disease and general manifestations in the form of rapid fatigue, loss of appetite, and progressive weight loss. The feeling of inadequate breathing can disturb patients who develop:

• Pleural cancer . Shortness of breath caused by restriction of lung excursion is possible both with a primary tumor and with metastatic lesions of the pleural sheets. Symptoms develop very quickly. In addition to an incomplete sparing breath, provoking a lack of air, pain in the affected half of the chest, weakness, and general exhaustion are expressed.
• Bronchioalveolar cancer . Difficulty in inhaling during physical exertion, and later at rest, is a late sign of a tumor. Often, shortness of breath develops against the background of a painful dry or profuse watery cough, indicates the presence of respiratory failure and precedes the onset of chest pain.

Heart diseases

Complaints about the lack of oxygen are one of the characteristic signs of cardiac shortness of breath, which is detected in cardiac diseases that occur with rhythm disturbance (tachycardia, extrasystole, WPW syndrome) or insufficient blood supply to the myocardium (angina pectoris, unstable angina pectoris, other forms of coronary heart disease). The severity of the symptom usually directly depends on the degree and form of heart failure. In mild cases, lack of air is felt after moderate physical exertion, with strong emotional experiences.

Pathological changes in the respiratory process in chronic heart failure are manifested by a feeling of lack of air and an increase in respiratory movements during simple physical exercises, daily work, fast, and then normal walking, at rest. Patients describe their sensation as a desire to inhale more air "full chest", note that they are "out of breath". Typical cyanosis (cyanosis) of the nasolabial triangle, nails, swelling of the lower extremities, severe fatigue, complaints of discomfort, heaviness, chest pain.

Emergency conditions

Shortness of breath with a feeling of acute air deficiency is a harbinger or symptom of a number of disorders requiring emergency medical attention. Together with dizziness, fog and “flies” before the eyes, “lightheadedness”, it indicates an approaching faint (syncope). Severe respiratory failure and severe difficulty in inhaling is observed in such acute conditions as:

• Cardiac asthma . Before an attack or during it, there is retrosternal stabbing, squeezing pain, interruptions in the work of the heart, and a strong heartbeat. An acute feeling of lack of oxygen is accompanied by cold sweat, cough (dry or with hemoptysis), fear of death, severe weakness. Acrocyanosis is noticeable - cyanosis of the fingers and toes, lips, tip of the nose, auricles. The skin looks pale with a grayish tint. The patient tries to take a vertical position (orthopnea). Cardiac asthma can manifest as myocardial infarction, heart defects, and other cardiopathology.
• Pulmonary embolism. In acute cases, shortness of breath occurs suddenly and usually has the character of an excruciating lack of air with attempts to inhale it. The patient strives to maintain a horizontal position (“lying low”). Breathing becomes more frequent up to 30-5 or more per minute, in the terminal stage it becomes rare, non-rhythmic, noisy (such as Biot, Cheyne-Stokes). The skin noticeably turns pale, with an increase in symptoms it becomes cyanotic, gray-ashy, with a lightning-fast form - a “cast-iron” color.
• Pulmonary bleeding . Shortness of breath with a felt incompleteness of inspiration develops and increases after an attack of persistent cough, at the end of which mucous sputum is coughed up with scarlet blood or its clots. In severe cases, dyspnea accompanies profuse bleeding from the respiratory tract, preceded by burning, tickling in the affected part of the chest. Against the background of frequent gurgling breathing, general disorders quickly increase: dizziness, noise in the head, ears. The skin turns pale and covered with cold sticky sweat, signs of acrocyanosis are noticeable.

Chest and lung injuries

Respiratory disorders in thoracic injuries can be both short-term and increasing. So, with bruised ribs, transient difficulty in breathing is secondary and is associated with restriction of respiratory movements due to chest pain with deep inhalation of air. With closed traumatic or spontaneous pneumothorax, complaints of insufficient oxygen supply, frequent breathing, blue lips, along with sharp stabbing chest pains radiating to the arm and neck, cold sweat, pressure drop, subcutaneous emphysema become leading in the clinical picture.

Neurotic disorders

Up to 75% of patients of neurologists and psychiatrists complain of frequent or constant lack of air, a feeling of a "damper" or other obstruction in the chest, which makes it difficult to fully breathe. Often, patients have associated emotional disorders - anxiety, hypochondria, phobias, in particular, the fear of death from suffocation. The key features of neurotic shortness of breath are the appearance or intensification after psychotraumatic situations, vivid, figurative descriptions of experiences, characteristic noise design (groans, groans, sighs). Shortness of breath is especially acute during a panic attack.

With cardioneurosis, somatoform dysfunction of the autonomic nervous system, vegetovascular dystonia, a combination of difficulty in breathing with constant or paroxysmal palpitations, headaches, tingling in the precordial region, chilliness, sweating, a tendency to turn pale or reddened is typical. A subjectively felt lack of incoming air (“empty breath”), forcing the patient to breathe often, deeply and noisily in the absence of somatic prerequisites, is one of the options for respiratory dysfunction in hyperventilation syndrome.

Survey

At the initial stages of the diagnostic search, patients with complaints of lack of air are managed by a local therapist or family doctor, who, taking into account the anamnesis and research results, appoint consultations of specialized specialists. For a quick comprehensive screening of pathologies accompanied by difficulty in breathing, the following are prescribed:

• X-ray studies . In the course of a survey chest x-ray, it is possible to identify changes characteristic of inflammatory processes, tumors, pneumosclerosis, and traumatic injuries. If necessary, sighting images, fluoroscopy, bronchography are performed.
• The study of the functions of external respiration . The most commonly performed spirometry, which allows you to objectively assess the main volume indicators of respiratory function. The method can be supplemented with plethysmography, gas analysis study of external respiration.
• Determination of the composition of blood gases . The analysis is aimed at detecting laboratory signs of respiratory failure. The main indicators of the gas composition of the blood are the levels of partial pressure of oxygen and carbon dioxide, the percentage and saturation of oxygen.
• Electrophysiological Methods . Electrocardiography is used to quickly detect arrhythmia, ischemia of the heart muscle. To obtain extended data on the activity of the heart, the ECG is supplemented with daily Holter monitoring, phonocardiography.
• Instrumental examination of the larynx . In the course of direct and indirect laryngoscopy, the condition of the mucous membrane of the organ, the vocal cords are assessed. When using a flexible or rigid fibrolaryngoscope, it is possible to biopsy suspicious areas and remove foreign bodies.

Possible inflammatory changes (increased ESR, leukocytosis), signs of anemia are determined by a general blood test. At further stages of the examination, tomographic methods are used (CT, MRI of the chest cavity), ultrasound of the heart, bronchoscopy, pleuroscopy, transbronchial lung biopsy, followed by a histological study of the material obtained. If heart disease is suspected, stress tests (veloergometry, treadmill test, etc.) are recommended.

oxygen therapy

Symptomatic therapy

Physiological difficulty in breathing goes away on its own after rest. In the event of a sudden lack of air, the patient must be reassured, seated on a chair, armchair, bed (with an elevated position and back support on the pillows). To facilitate breathing, it is necessary to remove tight clothing, a tight belt, unbutton the top buttons of a shirt or blouse. It is important to ensure the flow of oxygen into the room - open the window, open the window or door. In order to humidify the air, you can turn on the kettle, hang a damp sheet next to the bed, and fill the bath with water.

Self-administration of herbal sedatives is allowed. In heart or lung disease, another known cause of shortness of breath, the patient is advised to drink the drugs that he takes constantly. If within 10-15 minutes the condition does not improve, you should call an ambulance. With repeated attacks of lack of oxygen that pass on their own, a constant or periodic feeling of difficulty when inhaling, you should consult a doctor to find out the causes of the respiratory disorder.