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Shortness of Breath Health Article

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Diagnostic tests

BASIC DIAGNOSTIC TESTS. Patients who are seen in emergency rooms are given a chest x ray and electrocardiogram (ECG) to assist the doctor in evaluating abnormalities of the chest wall, also to determine the position of the diaphragm, possible rib fractures or pneumothorax, irregular heartbeat, or the adequacy of the supply of blood to the heart muscle. Also, the patient may be given a breathing test on an instrument called a spirometer to screen for airway disorders.

The doctor may order blood tests and arterial blood gas tests to rule out anemia, hyperventilation from an anxiety attack, or thyroid dysfunction. A sputum culture can be used to test for pneumonia.

SPECIALIZED TESTS. Specialized tests may be ordered for patients with normal results from basic diagnostic tests for dyspnea. High-resolution CT scans can be used for suspected airway obstruction or mild emphysema. Tissue biopsy performed with a bronchoscope can be used for patients with suspected lung disease.

If the doctor suspects a pulmonary embolism, he or she may order ventilation-perfusion scanning to inspect lung function, an angiogram of blood vessels, or ultra-sound studies of the leg veins. Echocardiography can be used to test for pulmonary hypertension and heart disease.

Pulmonary function studies or electromyography (EMG) are used to assess neuromuscular diseases. Exercise testing is used to assess dyspnea related to COPD, anxiety attacks, poor physical fitness, and the severity of lung or heart disease. The level of acidity in the patient's esophagus may be monitored to rule out GERD.

Treatment

Treatment of dyspnea depends on its underlying cause.

Acute dyspnea

Patients with acute dyspnea are given oxygen in the emergency room, with the following treatments for specific conditions:

Asthma. Treatment with Alupent, epinephrine, or aminophylline.
Anaphylactic shock. Treatment with Benadryl, steroids, or aminophylline, with hydrocortisone if necessary.
Congestive heart failure. Treatment with oxygen, diuretics, and placing patient in upright position.
Pneumonia. Treatment with antibiotics and removal of lung secretions.
Anxiety attacks. Immediate treatment includes antidepressant medications. If the patient is hyperventilating, he or she may be asked to breathe into a paper bag to normalize breathing rhythm and the oxygen level of the blood.
Pneumothorax. Surgical placement of a chest tube.

Alternative treatment

The appropriate alternative therapy for shortness of breath depends on the underlying cause of the condition. When dyspnea is acute and severe, oxygen therapy is used either in the doctor's office or in the emergency room. For shortness of breath with an underlying physical cause like asthma, anaphylactic shock, or pneumonia, the physical condition should be treated. Botanical and homeopathic remedies can be used for acute dyspnea, if the proper remedies and formulas are prescribed. If the dyspnea has a psychological basis (especially if it is caused by anxiety), acupuncture, botanical medicine, and homeopathy can help the patient heal at a deep level.

Prognosis

The prognosis for recovery depends on the underlying cause of the dyspnea, its severity, and the type of treatment required.

Prevention

Dyspnea caused by asthma can be minimized or prevented by removing dust and other triggers from the patient's environment. Long-term prevention of chronic dyspnea includes such lifestyle choices as regular aerobic exercise and avoidance of smoking.

BOOKS

Gillespie, D. J., and E. J. Olson. "Dyspnea." In Current Diagnosis. Vol. 9. Ed. Rex B. Conn, et al. Philadelphia: W. B. Saunders Co., 1997.

"On-Call Problems: Dyspnea." In Surgery On Call,ed. Leonard G. Gomella and Alan T. Lefor. Stamford: Appleton & Lange, 1996.

"Pulmonary Disorders: Dyspnea." In The Merck Manual of Diagnosis and Therapy. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.

Stauffer, John L. "Lung." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.

Rebecca J. Frey

KEY TERMS

Anaphylactic shock—A severe systemic reaction to an allergen that occurs in hypersensitive individuals. It can cause spasms of the larynx that block the patient's airway and cause dyspnea.

Dyspnea—A sensation of difficult or labored breathing.

Electromyography—A technique for recording electric currents in an active muscle in order to measure its level of function.

Orthopnea—Difficulty in breathing that occurs while the patient is lying down.

Paroxysmal nocturnal dyspnea (PND)—A form of dyspnea characterized by the patient's waking from sleep unable to breathe.

Platypnea—Dyspnea that occurs when the patient is sitting up.

Pneumothorax—The presence of air or gas inside the chest cavity.

Spirometer—An instrument that is used to test lung capacity. It is used to screen patients with dyspnea.

Stridor—A harsh or crowing breath sound caused by partial blockage of the patient's upper airway.

Wheezing—A whistling or musical sound caused by tightening of the air passages inside the patient's chest. Wheezing is most commonly associated with asthma.

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