The document discusses the management of dyspnea, defined as breathing discomfort with various causes including pulmonary, cardiac, and psychological factors. It covers assessment methods, including self-reports and various diagnostic tests, as well as treatment options like medications, surgical interventions, and physiotherapy techniques. The importance of education, exercise training, and self-care strategies for patients is also emphasized to enhance their coping mechanisms and improve quality of life.

1. BREATHLESSNES
MANAGEMENT
varsha

2. DYSPNEA :
American Thoracic Society defined dyspnea as
“a subjective experience of breathing discomfort
that consists of qualitatively distinct sensations that
vary in intensity.”

3. CAUSES OF DYSPNEA :
☞ Physiologic
☞ Restrictive Pulmonary
☞ Obstructive Pulmonary
☞ Cardiac
☞ Circulatory
☞ Chemical
☞ Neurologic
☞ Psychogenic
☞ Mechanical

4. DYSPNEA ASSESSMENT

5. Gold standard for diagnosis and assessment is
patient’s self report
•Asthma ➜ tightness in the chest
•Interstitial disease ➜ rapid breathing
•Congestive heart failure ➜ suffocating
•COPD ➜ unable to take enough air in

6. History
• Onset
• Duration & frequency
• Aggravating and relieving factors
• Diurnal variation
• Positional variation
• Associated factors
• Severity
• Occupational and personal history

7. • Standard spirometry and lung volume and
capacity measurements
• Lung volume measurement by plethysmography
• Gas dilution techniques
• Assessment of lung function following
administration of an inhaled bronchodilator

8. • Measurement of gas diffusion
• Pulse oximetry ( arterial oxygen saturation)
• Arterial blood sampling (hypercapnia)
• Mixed venous measurement
• Also incorporation of co-morbidities and
psychological status in evaluation

9. •In 1952, Fletcher published a 5-point rating scale,
which was employed by the Pneumoconiosis
Research Unit to rate the impact of dyspnea on
activities.
•A revised version of the scale is now widely known
as Medical Research Council (MRC) scale.

12. •Baseline Dyspnea Index
•Transition Dyspnea Index
•University of California at San Diego Shortness of
Breath Questionnaire (UCSDQ)
•Evaluation of dyspnea during supervised tasks (
cycle ergometry, 6-min walk test)
•Exercise testing: ventilatory reserve during
exercise

16. Dyspnea and Quality of Life
•The Chronic Respiratory Disease Questionnaire
(CRQ)
•The Saint George Respiratory Questionnaire (SGRQ)
•The Pulmonary Functional Status and Dyspnea
Questionnaire (PFSDQ))
•The Pulmonary Function Status Scale (PFSS)
•SF-36

18. Medical Management
Opiods – first line of therapy for symptomatic
control of dyspnea
Anxiolytics – prescribed for anxiety related to
dyspnea
Oxygen
Symptomatic management of the underlying cause.

19.  Bronchodilators in case of narrowed airways
 Antibiotics in case of respiratory infections
 Anti-inflammatory agents for inflammation in
the respiratory tracts
 Steroids
 Inhaled β2 adrenergic agonists
 Inhaled anti-cholinergics
 Sustained release theophylline
 Methylxanthines
 Resection, chemotherapy, radiotherapy, laser,
thoracocentesis and fluid drainage in case of
cancer related complications

20. •Surgical Interventions for conditions like pleural
effusion, pericardial tamponade and endobronchial
obstruction.
•Thoracocentesis, tube thoracostomy or
pleuroperitoneal shunts for pleural effusion
•Pericardial fluid drainage for tamponade.
•Endobronchial brachytherapy, ablation with laser,
cautery and insertion of endobronchial stents for
endobronchial obstructions.

21. Reducing lung hyperinflation:
1. surgical volume reduction : Massive
bullectomy ( >1/3rd of hemithorax) and
lung volume reduction surgery.
2. CPAP

22. Physiotherapy Management
Relaxation Positions to be taught in case of an
acute exacerbation to relieve dyspnea.
Leaning forward position improve
overall inspiratory muscle strength (O’Neil 1983),
increase diaphragm recruitment,
reduce participation of neck and upper costal
muscles in respiration
decrease abdominal paradoxical breathing,

27. Relaxation techniques
-Jacobson’s progressive muscle relaxation
techniques
-Reciprocal relaxation
Positioning
with hip and knee in flexion for facilitation of the
diaphragm and decreasing tension in the abdominal
muscles

29.  Breathing Retraining
- Diaphragmatic breathing to improve
inspiration (restrictive lung diseases)
- Pursed lip breathing to improve expiration
(obstructive lung diseases)
- Segmental breathing in case of decreased
hemithorax expansion

34. Diaphragmatic Facilitation
 Relaxation
 Repattern techniques to prolong expiration
 Upper chest inhibition to facilitate diaphragm
 PNF technique of normal timing
 Scoop technique at the end of expiration and
start of inspiration

35. Postures for improved breathing and better
expansion of both the lungs
 Preferably side lying or quarter-turn to ensure
that the good lung is downwards.
 Use PNF technique timing for emphasis and
restrict the good lung thereby facilitating
expansion of the affected lung

36. Exercise Training
 Targeted high-intensity exercise training
improves aerobic capacity, thereby decresing
exertional dyspnea.
 Generalised graded exercises involving walking
and stair climbing can be used.

37. Desensitization
 Exposure to greater than usual sensations of
dyspnea in a safe environment”
Aim: to increase a patient's self-efficacy for coping
with a symptom and potentially heighten the
perceptual threshold
 Exercise in safe environment - to overcome
apprehension, anxiety, and/or fear associated
with exertional dyspnea
 Exercise training – “the most powerful means of
desensitization to dyspnea”

38. Supplemental Oxygen during exercise
-Reduction in blood lactate
-Improves ventilatory muscle function
Chest wall vibration to the intercostal muscles
reduce dyspnea
Low levels of CPAP in acute bronchoconstriction
during asthma attack, in patients being weaned off
the ventilator and while exercise in patients with
advanced COPD.

39. • Improving inspiratory muscle strength and
endurance.
• Inspiratory muscle training.
•Activity pacing and energy conservation.
• Upper limb assisted thoracic mobility exercise.
•Nutrition

40. Unsupported limb training

41. Resistance training

43. Y motivation is important?

44. Education
 About disease, prognosis, complications,
management and its limitations
 Only for asthma, evidence established
 self-care strategies is thought to increase the
patients' confidence
•avoiding triggers,
•symptom monitoring,
•medication adjustment,
•recognizing problems as they arise

45. Energy conservation

47. Subjective relief after training…