CSI - COPD Flashcards
(47 cards)
What are the two broad causes of breathlessness?
- respiratory
- cardiovascular/systemic
Why is considering breathlessness important?
- Breathlessness is a symptom, not a condition itself
- There’s often more than one cause of breathlessness
- Conditions that cause long-term breathlessness can often be treated, but some cannot be fully reversed
- It’s important to learn how to manage long-term breathlessness
Why can lung conditions cause breathlessness?
- lung disease can cause breathlessness for many reasons
can cause the airways to become inflamed and narrowed,
or filled with - phlegm, so it’s harder for air to move in and out of the lungs
- can make the lungs stiff and less elastic so it’s harder for
them to expand and fill with air
What lung conditions cause long-term chronic breathlessness?
chronic obstructive pulmonary disease (COPD)
interstitial lung disease (ILD), including
pulmonary fibrosis and sarcoidosis
bronchiectasis
industrial or occupational lung diseases such as
asbestosis, which is caused by being exposed to
asbestos
lung cancer
What are lung conditions that cause short-term (acute)
breathlessness?
flare-up of asthma or COPD
pulmonary embolism or blood clot on the lung
lung infection such as pneumonia or
tuberculosis
pneumothorax or collapsed lung
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 an infection
Why can heart conditions cause breathlessness?
can cause long-term breathlessness
can be due to problems with the rhythm, valves or
cardiac muscles of the heart
heart can’t increase its pumping strength in
response to exercise, or the lungs become congested
and filled with fluid
often worse when supine (so when sleeping)
Which heart conditions cause acute breathlessness?
a heart attack
an abnormal heart rhythm - you might feel your heart misses beats or you might
experience palpitations
Why is anxiety and breathlessness be interlinked?
feeling short of breath when anxious or afraid is a normal response to stressful situations; the body is preparing for action
as you get more anxious, you may start to breathe faster and tense your breathing muscles
physical health can also impact mental health, especially if living with a lung condition
you might get anxious if you don’t feel in control of your
condition
if you have a lung condition, you may have symptoms that make you feel anxious
sometimes the symptoms of lung conditions e.g.
breathlessness, tightness in your chest or getting tired very easily are similar to feelings of anxiety
What happens to the heart and muscles during panic attacks?
when body’s normal response is exaggerated, you get a rapid build-up of physical responses; breathing quickens and your body also releases hormones so your heart
beats faster and your muscles tense
What are some symptoms of 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 that you’re not connected to your body
What is the link between anxiety and hyperventilation?
- If you start to breathe too quickly in response to a panic attack, you may breathe in more
oxygen than your body needs. - This is called hyperventilation or over-breathing.
- When you do this, the delicate balance of the gases in your lungs is upset.
- An amount of carbon dioxide normally stays in the blood. If you breathe in too much air too
often, the carbon dioxide is pushed out through the lungs and this affects the messages the
brain receives to tell you to breathe
Why does being unfit cause breathlessness?
When we are unfit, our muscles (including respiratory
muscles) get weaker.
Weaker muscles need more oxygen to work, so the
weaker our muscles, the more breathless we feel.
It’s really important to keep active to manage
breathlessness bett
Why does being an unhealthy weight cause breathlessness?
If you’re underweight, your respiratory muscles will be weaker.
If you’re overweight, it takes more effort to breathe and move around.
Having more weight around the chest and stomach restricts how much your lungs can
move.
People who are a BMI of 25 or more are more likely to get breathless compared to people with a healthy weight.
People who are severely overweight can develop obesity hypoventilation syndrome; when poor breathing leads to lower oxygen levels and higher carbon dioxide levels in
their blood.
Maintaining a healthy weight may help you to manage your breathlessness better and be more active
What are other causes of long term breathlessness?
smoking
conditions that affect how your muscles work, such as muscular dystrophy, myasthenia
gravis or motor neurone disease
postural conditions that alter the shape of your spine, and affect how your ribs and
lungs expand - for example scoliosis and kyphosis
anaemia, when a lack of iron in the body leads to fewer red blood cells
kidney disease
thyroid disease
What are patient barriers to diagnosing COPD?
Patients may:
think breathlessness is as a normal part of
ageing, so don’t tell their doctor
feel responsible for causing their illness and
don’t feel they deserve help
not realise they can get any help for their
breathlessness
not actually feel out of breath when they see
their doctor (would be sitting down and may
have only walked a short distance), so may
forget what their breathlessness feels like
and find it hard to describe
What tools should patients use to diagnose COPD?
Patients should:
Use an online breath test to find out if your
breathlessness is something to get checked out
with your doctor.
bring someone with them who can help
describe their breathlessness
think about how they will be describing their
breathlessness in advance of seeing a doctor e.g.
what they used to be able to do but can’t any
more
what people of their age around them do that
they find difficult
what their personal goals are for their day-today activity
use local landmarks such as bus stops, shops
and hills to help you describe these thing
record the sort of activities that make them out
of breath to show their doctor what it looks or
sounds like
What tools will doctors use to investigate breathlessness?
Doctors will:
Use the MRC breathlessness scale
Ask questions about breathlessness
Do some tests to help diagnose what’s causing
the breathlessness
What is the MRC?
MRC = Medical Research Council
The scale health care professionals usually use to
measure breathlessness
This does not recognise other aspects of breathlessness – such as how you think or feel about getting out of breath.
The MRC scale shows what your breathlessness stops you doing.
Your grade is the one that describes you when you’re at
your best
What are the grades on the MRC breathlessness scale?
1 = not troubled by breathlessness except on strenuous exercise
2 = short of breath when hurrying on the level or walking up a slight hill
3 = Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4 = Stops for breath after walking about 100 yards or after a few minutes on level ground
5 = Too breathless to leave the house, or breathless when undressing
What questions doctors might ask about breathlessness?
duration
onset
frequency
pattern
time
relieving factors e.g. lying flat
exacerbating factors e.g. pollen, pets, medication
smoking
coughing/phlegm
chest pain, palpitations, ankle swelling
normal activity levels
occupation
whether breathlessness is related to certain times at work
history of heart, lung or thyroid disease, or of anaemia
family history of breathlessness
lifestyle changes made due to breathlessness (if any)
feeling worried, frightened, depressed or hopeless
coping mechanisms
What physical tests doctors may carry out to diagnose cause of breathlessness?
breathing and lung function tests
Respiration rate (breaths per min)
Chest auscultation (listening)
Look and feel how chest moves during breathes
heart rate and rhythm
check if fluid is building up in ankles or lungs
blood pressure and temperature
check height, weight, waist and BMI
examine head, neck and armpits to see if lymph glands are swollen
inspect eyes, nails, skin and joints
check blood sats with a pulse oximeter
if there are signs that patient is anxious/depressed, a short questionnaire
Diagnosing breathlessness: What are additional possible tests at GP surgery, local testing centre or hospital?
chest X-ray
spirometry test
electrocardiogram or ECG - if breathlessness is intermittent, wear a portable recorder for
24 hours or 7 days to record heart’s electrical activity
echocardiogram - this is a non-invasive ultrasound of heart which can tell how well it’s
working
blood tests to detect anaemia, allergies or any thyroid, liver, kidney or heart problems
What is meant by shortness of breath on exertion?
Shortness of breath on exertion: when you have additional requirements on top of your baseline
needs, and do not acquire enough oxygen to meet the needs
What are the respiratory differential diagnoses that can present with shortness of breath on exertion?
Asthma
COPD
Pulmonary fibrosis (lung tissue becomes fibrotic
and scarred)
Lung cancer
Pulmonary embolism
Pneumothorax
Lower respiratory tract infection
