Healthcare

BREATHING DIFFICULTIES (SHORTNESS OF BREATH) Part I 

Shortness of breath (SOB) is the perception of the need for additional effort to breath. It is described in different ways by people based on how best they can explain what they feel. Some will say they have chest tightness that feels as if they have to use extra effort to force air through the lungs. Some others will feel like they have to make additional effort to achieve breaths that should naturally be effortless. Others still have to stop to catch their breath, or it is like I have done a lot of exercise when I have barely walked few blocks or climbed a few steps.  When we breathe, we take in oxygen from the air which is carried through the blood and delivered to the tissues to be used for various metabolic processes. The tissues then give up carbon dioxide which was generated from various processes to be taken away from the body.  This air exchange involves the lungs and the heart that pumps the blood which carries both the oxygenated and deoxygenated blood. Disturbances in the structure and function of either of these two organs form the basis of a lot of the causes of SOB. SOB can occur suddenly (acute SOB) or develop gradually over a period of time (chronic SOB). There are other times that people with a baseline chronic SOB develop an acute problem that makes their breathing burdensome.  A sudden onset SOB is a medical emergency; have the person taken to the hospital immediately.  Causes of Shortness of BreathThe list is so long that it cannot be exhausted in a single article.  In this article we will focus on some of the causes originating from the lungs. For a simpler understanding imagine the structure and function of the lungs. The process of breathing involves the entire respiratory system. The air gets in through the large wind pipe (trachea) which divides into either lung and then, further into small units (bronchioles) and eventually terminates in the alveoli (thin tightly packed cells). Blockage of the windpipe: Such as an object in a child, food bolus in someone choking will cause sudden SOB in someone who otherwise is very well. Damage to the Bronchi and bronchioles (Bronchitis and bronchiolitis): This can present both as acute or chronic SOB depending on the cause. If the muscles of the bronchial wall go into a spasm, or there is a lot of inflammation, it can present with acute (SOB). In asthmatics, it is spasm superimposed on inflammation that causes sudden SOB. When narrowing of the passage way occurs, there may be associated wheezing as air is forced through the narrow passage.  Air trapping in the alveoli: When air is trapped in the alveoli, it decreases effect area available for air exchange. There is a gradual increase in carbon dioxide retention in the body as oxygen availability decreases. This invariably occurs in smokers. This presents as a gradual onset SOB. The air trapping is called Emphysema. Fluid in the lungs: Whatever causes fluid retention in the lungs also reduces effective area available for gas exchange. Fluid can get into the lungs with infection, heart failure and kidney failure.  Other causes of fluid retention in the lungs are cancer, and trauma with bleeding into the lungs.Decrease blood flow to the lungs or increased pressure in blood vessels in the lung: If there is a sudden block in the blood vessels of the lung as in pulmonary embolism, it causes acute SOB. Pulmonary hypertension (when pressure in the pulmonary artery is high), it can present with SOB. Structural distortion of the lung tissue itself: Several diseases, occupational exposures, chemicals and so on can damage the lung tissue. They are a big spectrum called interstitial lung diseases, lung involvement in diseases that affect the immune system, sarcodosis, and many more. Compression of the effective lung space: When the lungs are compressed, it does not leave room for full expansion, thereby decreasing air exchange. This is how obesity can cause SOB. Take Home message Acute Shortness of breath is a medical emergency that can result in death. Seek help immediately in an hospital. Feeling that you need extra effort to breath requires further investigation as to the cause, consult your doctor. Smoking cessation goes a long way to decrease the rate at which lung function worsens, irrespective of the initial cause of the SOB. Remember that SOB can be a pointer to underlying lung or heart diseases, never dismiss SOB.Article to be continued…….Dr. Dairo can be reached at Amazing Medical Services, 110-16 Sutphin Blvd , Jamaica NY 11435 or by phone @ 718 526 7600 .