Breathlessness is a common symptom or complain received by a family practitioner. This presentation is intended to provide important basic information on Breathlessness

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Respiratory Diseases
Management Course
2017-18
22/04/2018 Ahmedabad

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Breathlessness
Dr. Abhay S. Dikshit M.B.B.S. F. C. G. P.
Senior Family Physician
AHMEDABAD
(M) 9327018200

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What is Breathlessness?
• Breathlessness –dyspnoea refers to the sensation
of shortness of breath or difficulty breathing. It is
distressing and frightening for patients and carers.
• Breathlessness may occur in conjunction with other
symptoms such as cough, chest pain and fever.

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What is Breathlessness?
• Getting out of breath is normal. It’s a natural response
when body needs more oxygen and energy when you do
something that requires physical effort .
• Getting out of breath when we exercise is a positive
reaction and is part of keeping our bodies fit and strong.

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Types of Breathlessness
• Acute breathlessness: If you get out of breathless suddenly and
unexpectedly for a short time, this is called acute breathlessness. Acute
breathlessness usually needs to be tested or treated straight away.
• Chronic or long-term breathlessness: Some people get out of
breath every day when they’re not physically exerting themselves. They
unexpectedly find it difficult or uncomfortable to breathe, and may feel
they can’t control their breathing. This long-term breathlessness is
known as chronic breathlessness. It often develops gradually and lasts
for weeks, months or years.

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What one feel when breathless?

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Causes of Breathlessness
The 4 main causes are:
• Lung conditions
• Heart conditions
• Anxiety
• Being unfit
There are other reasons too.

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LUNG Conditions
• Lung conditions that cause long-term (chronic) breathlessness
include:
• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Interstitial lung disease (ILD), including pulmonary fibrosis
• Bronchiectasis
• Industrial or occupational lung diseases such as asbestosis, which
is caused by being exposed to asbestos
• Lung cancer

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LUNG Conditions
Some lung conditions can also cause short-term (acute)
breathlessness. These include:
• a flare-up of asthma or COPD
• a pulmonary embolism or blood clot on the lung
• a lung infection such as pneumonia or tuberculosis
• a pneumothorax or collapsed lung
• a build-up of fluid in your lungs or the lining of your lungs – this
might be because your heart is failing to pump efficiently or may
be because of liver disease, cancer or infection

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Heart Conditions
Long term breathlessness due to heart failure.
• Problems with the rhythm, valves or cardiac muscles of the heart.
• The heart is not able to increase its pumping strength in response to exercise, or because
the lungs become congested and filled with fluid.
• Often this is worse when lying flat so breathlessness due to heart failure can be worse at
night or when asleep.
Heart conditions that cause acute breathlessness include:
• Heart attack
• Abnormal heart rhythm.
• Heart misses beats
• Palpitations

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ANXIETY
• Some people feel short of breath when they’re anxious or afraid.
• Your physical health can also impact on your mental health.
• As your body tries to take in more oxygen, your breathing quickens. Your
heart beats faster and your muscles tense.
Panic attacks
• During a panic attack, you might feel you can’t breathe and, have a
pounding heart, feel faint, sweat, feel sick, have shaky limbs, feel you’re not
connected to your body

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Being Unfit
• When we are unfit, our muscles get weaker. Weaker muscles
need more oxygen to work.
• If you’re underweight, your breathing muscles will be weaker.
• If you’re overweight, it takes more effort to breathe and move
around.
• People who are severely overweight can develop obesity
hypoventilation syndrome.

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Other Reasons
• Smoking
• Muscular dystrophy, myasthenia gravis or motor neurone
disease
• Scoliosis and kyphosis
• Anaemia
• Kidney disease
• Thyroid disease

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DIAGNOSIS
Doctor should ask:
• How long have you been feeling breathless, how quickly did it come on?
• Does it come and go or is it there all the time?
• Does it start or get worse at any particular time of day?
• Does it come on or get worse when you lie flat?
• Does anything bring it on? For example, pollen, pets or medication?
• Do you smoke?
• Do you also have a cough, or bring up phlegm?
• Do you get chest pain, palpitations or ankle swelling?
• What’s your job or occupation?
• Do you have a history of heart, lung or thyroid disease or of anaemia?
• Do you feel worried or frightened, depressed or hopeless?

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Diagnosis
General examination
• Check for breathing rate & sounds.
• Check heart rate and rhythm
• Check for oedema
• Check blood pressure and temperature
• Check height, weight, waist and body mass index
• Examine for swollen lymph glands
• Look at eyes, nails, skin and joints
• Check blood oxygen levels with a pulse oximeter

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Special Tests
• Chest X-ray
• Spirometry test
• ECG.
• If breathlessness is intermittent you might be asked to wear a
portable recorder to record heart’s electrical activity
• Echocardiogram.
• Blood tests to detect anaemia, allergies or any thyroid, liver,
kidney or heart problems

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• Breathlessness is also affected by
how you breathe, your lifestyle and
how you think and feel about your
breathing.
Management of Breathlessness

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Management of Breathlessness

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Breathing Habits
• Unhelpful breathing habits can make you feel more out of
breath.
• When you’re out of breath, you may feel like you need
more air. So you may start to take more air into your lungs
or breathe faster.
• Breathing techniques to breathe more efficiently and to
feel in control of breathing.

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Breathing Control
• Breathing control means breathing gently, using the least effort.
This type of breathing is commonly used in yoga.
• When you’re sitting, are relaxed and not out of breath.
• Put one hand on your chest and the other on your abdomen
• Close your eyes to help you relax and focus on your breathing
• Slowly breathe in through your nose, with your mouth closed.
• Breathe out through your mouth. Your abdomen will fall gently.
• Try to use as little effort as possible and make your breaths slow,
relaxed and smooth.

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Breathing Techniques
1. Blow-as-you-go
helps make tasks and activities easier. Use it while you’re
doing something that makes you breathless. Breathe in
before you make the effort. Then breathe out while you’re
making the effort. For example, when standing up,
breathe in before you stand up, and then blow out as you
stand up.

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Breathing Techniques
2. Paced breathing
• useful when you are active, for example, walking or
climbing stairs. Count to yourself as you walk or move. For
example, breathe in for one step and then take either one
or two steps as you breathe out.
• Try different combinations to find what works best for you
- for example, one step in, two steps out.

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Breathing Techniques
3. Pursed-lips breathing
• can be used at any time to help you control your breathing. This
helps to empty all the air out of your lungs and is particularly
useful for people with COPD as the narrowed airways can trap air
in the lungs.
• Breathe in gently through your nose, then purse your lips. Blow
out with your lips in this pursed position. Blow out only for as long
as is comfortable – don’t force your lungs to empty.

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Positions to help you recover
from breathlessness
• Have your feet slightly apart, about one foot or 30cms away from
the wall. Relax your hands down by your sides.
Stand leaning backwards
or sideways against a wall
There are different positions to
Get relief from breathlessness, in
Obstructive& Restrictive lung diseases

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Tips to manage breathlessness
• Use a towelling robe after showering or bathing.
• Try using a handheld battery fan near your face.
• Use a small table or cart with wheels to move things around your
home.
• Use pole or tongs with long handles to reach things.
• Put items that you use often in easy-to-reach places.
• Keep your clothes loose, and wear clothes and shoes that are easy
to put on and take off.
• Use a wheeled walking frame
• Some people find carrying a stick helps them.

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Management of Sex &
Breathlessness
6 Commandments to have good sex with breathlessness :-
• Get fit
• Pick a good time
• Pick a good place
• Have your symptoms under control
• Experiment
• Take a break

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GET FIT
• Pulmonary rehabilitation and exercise can help you be active for
longer.
• Sexual activity, including intercourse, oral sex and masturbation,
requires energy.
• Heart rate and blood pressure might go up for a short time..
• Slower erections and delayed orgasms are normal as you get
older.

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Pick a Good Time
• Have sex when you’re rested and your
breathing feels comfortable.
• Make sure you’re comfortable and relaxed.
• Wait for two hours after a heavy meal.
• Avoid alcohol.

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Pick a good place
• You’ll know that sometimes the environment
can affect your breathing, so try to avoid
things that can trigger shortness of breath.
• Avoid dust, house mites, pet dander, smoke or
heavy fragrances.

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Have your symptoms under
control
• Avoid having sex in the morning when
many people cough up more phlegm.
• If you use an inhaler to open up your
airways, try taking one or two puffs
before starting sexual activity.

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Try Different Positions
• Intimacy is a source of pleasure and relaxation. Sex is also
about enjoyment and fun.
• Be prepared to try different ways to express your affection.
• Try different positions to find which ones work best for you
both.
• The key is to avoid positions that put pressure on the chest.
• You could also try using pillows to maximise your comfort.

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Take a break
• If you start to feel breathless, try slowing down or taking a
rest.
• Try to change positions or taking turns with sexual activity.
• There’s no need to stop giving or getting hugs.
• If you get very short of breath, try to pause and take some
slow, deep breaths.
• The nebulizer or oxygen can be used during the activity.

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Thank You

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Module Coordinator