Breathing difficulty

Definition Breathing difficulty involves a sensation of difficult or uncomfortable breathing or a feeling of not getting enough air. Alternative Names Shortness of breath; Breathlessness; Difficulty breathing; Dyspnea Considerations No standard definition exists for difficulty breathing. Some people may feel breathless with only mild exercise (for example, climbing stairs), even though they do not have a specific disorder. Others may have advanced lung disease but never feel short of breath. Wheezing is one form of breathing difficulty. Common Causes Shortness of breath has many different causes.

A blockage of the air passages in your nose, mouth, or throat may lead to difficulty breathing. Heart disease can cause breathlessness if your heart is unable to pump enough blood to supply oxygen to your body. If your brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur. Sometimes emotional distress, such as anxiety, can lead to difficulty breathing.

The following problems may cause breathing difficulty: Problems with the lungs

Pneumonia (severe) Bronchiolitis Chronic obstructive pulmonary disease (COPD), asthma, and other chronic lung problems Blood clot in the arteries of the lungs (pulmonary embolism)

Pulmonary hypertension

Problems with the airways leading to the lungs

Choking on something stuck in the airways Croup Epiglottitis

Problems with the heart

Heart attack or angina Heart failure Heart rhythm disturbances (arrhythmias) Children born with heart defects (congenital heart disease)

Other problems

Rapid ascent to high altitudes, where there is less oxygen in the air A large amount of dust in the environment Allergies (such as to mold, dander, or pollen) Lack of exercise Obesity Compression of the chest wall Panic attacks Hiatial hernia

Home Care In some circumstances, a small degree of breathing difficulty may be normal. Severe nasal congestion is one example. Strenuous exercise, especially when you do not exercise regularly, is another example. If difficulty breathing is new or is getting worse, this may indicate a serious problem. Though many causes are harmless and easily corrected, any breathing difficulty requires that you contact your health care provider. If your doctor has been treating you for a long-term problem with your lungs or heart, follow your health care provider's directions to help with that problem. (See: asthma, COPD, heart failure)

See your health care provider if breathing difficulty starts suddenly or is severe, or if any of the following occur with breathing difficulties:

Chest discomfort, pain, or pressure Shortness of breath after only slight exertion or while at rest Shortness of breath that wakes you up at night or requires you to sleep propped up to aid breathing Wheezing Having inhaled or choked on an object (foreign object aspiration or ingestion) Tightness in the throat or a barking, croupy cough Development of a fever or significant cough

What to expect at your health care provider's office You may be asked the following medical history questions:

Do you notice shortness of breath? Do you make grunting sounds while breathing? Do you have to work hard to breathe? How long have you had breathing difficulty? Did it slowly progress over weeks to months? Did it begin recently? Did it begin suddenly? Did it come on slowly (gradual onset)? Is there a sequence of separate occurrences (episodes)? How long does each last, and does each episode have a similar pattern? Has the breathing difficulty worsened recently? Does breathing difficulty cause you to wake up at night (paroxysmal nocturnal dyspnea)? Does the amount of breathing difficulty change (variable over hours)? Does breathing difficulty occur at rest? How long does each episode last? Is it worse when you lie flat (orthopnea)? Is it worse when you change body position? Did it develop within 4 to 6 hours after exposure to something that you are or may be allergic to (antigen)? Is it worse after exercise? Does shortness of breath occur only when you are wheezing? Is your breathing pattern irregular?

Do you draw back the chest muscles with breathing (intercostal retractions)? What other symptoms do you have?

The physical examination will include a thorough check of your lungs, heart, and upper airway passages. Tests that may be performed include the following:

Blood tests (may include arterial blood gases) Measurement of blood oxygen saturation (pulse oximetry) ECG X-ray of the chest Pulmonary function tests Exercise testing CT scan of the chest Echocardiogram

In severe cases of difficulty breathing, hospitalization may be required. Many different medications aimed at treating the cause of breathing difficulty may be used. If your blood oxygen level is very low, you may need to receive oxygen. High doses of supplemental oxygen may be hazardous for some patients, however. Oxygen is not necessary in all cases of shortness of breath. Lungs

The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged. Emphysema

Emphysema is a lung disease involving damage to the air sacs (alveoli.There is progressive destruction of alveoli and the surrounding tissue that supports the alveoli.

Pneumonia
Definition Pneumonia is a respiratory condition in which there is inflammation of the lung. Community-acquired pneumonia refers to pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility). Alternative Names Bronchopneumonia; Community-acquired pneumonia

Causes, incidence, and risk factors Pneumonia is a common illness that affects millions of people each year. Germs called bacteria, viruses, and fungi may cause pneumonia. Ways you can get pneumonia include:

Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs. You may breathe some of these germs directly into your lungs. You breathe in (inhale) food, liquids, vomit, or secretions from the mouth into your lungs (aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious. In adults, bacteria are the most common cause of pneumonia.

The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus). Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, , and Chlamydophila pneumoniae. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is impaired (due to AIDS or certain medications that suppress the immune system). Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella pneumoniae, or Haemophilus influenzae are other bacteria that can cause pneumonia. Tuberculosis can cause pneumonia in some people, especially those with a weak immune system.

Viruses are also a common cause of pneumonia, especially in infants and young children. Risk factors (conditions that increase your chances of getting pneumonia) include:

Cigarette smoking Recent viral respiratory infection (common cold, laryngitis, influenza) Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)

Chronic lung disease (COPD, bronchiectasis, cystic fibrosis) Cerebral palsy Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus Living in a nursing facility Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions) Recent surgery or trauma Immune system problem (See also: Pneumonia in immunocompromised host)

Symptoms The most common symptoms of pneumonia are:

Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus) Fever, which may be mild or high Shaking chills Shortness of breath (may only occur when you climb stairs)

Additional symptoms include:

Sharp or stabbing chest pain that gets worse when you breathe deeply or cough Headache Excessive sweating and clammy skin Loss of appetite, low energy, and fatigue Confusion, especially in older people

Signs and tests If you have pneumonia, you may be working hard to breathe, or breathing fast. Crackles are heard when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall). The health care provider will likely order a chest x-ray if pneumonia is suspected. Some patients may need other tests, including:

CBC to check white blood cell count Arterial blood gases to see if enough oxygen is getting into your blood from the lungs CT scan of the chest Gram's stain and culture of your sputum to look for the organism causing your symptoms Pleural fluid culture if there is fluid in the space surrounding the lungs

Treatment Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. It is very important that your antibiotics are started very soon after you are admitted. You are more likely to be admitted to the hospital if you:

Have another serious medical problem Have severe symptoms Are unable to care for yourself at home, or are unable to eat or drink Are older than 65 or a young child Have been taking antibiotics at home and are not getting better

However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have a viral or bacterial pneumonia, so you may receive antibiotics. Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin). Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary disease, or emphysema, kidney disease, or diabetes are often given one of the following:

Fluoroquinolone (levofloxacin (Levaquin), sparfloxacin (Zagam), gemifloxacin (Factive), or moxifloxacin (Avelox)

High-dose amoxicillin or amoxicillin-clavulanate, plus a macrolide antibiotic (azithromycin, clarithromycin, or erythromycin) Cephalosporin antibiotics (for example, cefuroxime or cefpodoxime) plus a macrolide (azithromycin, clarithromycin, or erythromycin)

If the cause is a virus, typical antibiotics will NOT be effective. Sometimes, however, your doctor may use antiviral medication. You can take these steps at home:

Drink plenty of fluids to help loosen secretions and bring up phlegm. Get lots of rest. Have someone else do household chores. Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum. Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.

Expectations (prognosis) With treatment, most patients will improve within 2 weeks. Elderly or debilitated patients may need longer treatment. Those who may be more likely to have complicated pneumonia include:

Older adults or very young children People whose immune system does not work well People with other, serious medical problems such as diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up. Complications Possible complications include:

Respiratory failure, which requires a breathing machine or ventilator Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery. Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure

Call your doctor if you have:

Worsening respiratory symptoms Shortness of breath, shaking chills, or persistent fevers Rapid or painful breathing A cough that brings up bloody or rust-colored mucus Chest pain that worsens when you cough or inhale Night sweats or unexplained weight loss Signs of pneumonia and weak immune system, as with HIV or chemotherapy

Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is retracting while breathing. Prevention Wash your hands frequently, especially after blowing your nose, going to the bathroom, diapering, and before eating or preparing foods. Don't smoke. Tobacco damages your lung's ability to ward off infection. Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:

Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.

Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given yearly to protect against new virus strains. Hib vaccine prevents pneumonia in children from Haemophilus influenzae type b. A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent pneumonia caused by respiratory syncytial virus.

If you have cancer or HIV, talk to your doctor about additional ways to prevent pneumonia and other infections.

Bronchiolitis
Definition Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles), usually due to a viral infection. Symptoms Some children have infections with few or minor symptoms. Bronchiolitis begins as a mild upper respiratory infection. Over a period of 2 - 3 days, it can develop into increasing respiratory distress with wheezing and a "tight" wheezy cough. The infant's breathing rate may increase (tachypnea), and the infant may become irritable or anxious-looking. If the disease is severe enough, the infant may turn bluish (cyanotic), which is an emergency. As the effort of breathing increases, parents may see the child's nostrils flaring with each breath and the muscles between the ribs retracting (intercostal retractions) as the child tries to breathe in air. This can be exhausting for the child, and very young infants may become so tired that they have difficulty maintaining breathing. Symptoms include:

Bluish skin due to lack of oxygen (cyanosis) Cough, wheezing, shortness of breath, or difficulty breathing

Fever Intercostal retractions Nasal flaring in infants Rapid breathing (tachypnea)

Causes & Risk Factors Bronchiolitis usually affects children under the age of 2, with a peak age of 3 - 6 months. It is a common, and sometimes severe illness. Respiratory syncytial virus (RSV) is the most common cause. Other viruses that can cause bronchiolitis include:

Adenovirus Influenza Parainfluenza

The virus is transmitted from person to person by direct contact with nasal fluids, or by airborne droplets. Although RSV generally causes only mild symptoms in an adult, it can cause severe illness in an infant. Bronchiolitis is seasonal and appears more often in the fall and winter months. It is a very common reason for infants to be hospitalized during winter and early spring. It is estimated that by their first year, more than half of all infants have been exposed to RSV. Risk factors include:

Exposure to cigarette smoke Age younger than 6 months old Living in crowded conditions Lack of breast-feeding Prematurity (being born before 37 weeks gestation)