L23. Physiology of Breathlessness Flashcards Preview

03. Respiratory > L23. Physiology of Breathlessness > Flashcards

Flashcards in L23. Physiology of Breathlessness Deck (20):
1

What is breathlessness?

A group of sensations with multiple qualitative descriptors making an all-embracing definition is difficult.

2

When does breathlessness arise?

When there is a RECOGNITION by a person of an INAPPROPRIATE relationship between respiratory WORK and total BODY WORK

3

What is the perception of breathing akin to?

Sensory modalities (like pain or sound) - the sensation arises at a conscious level.

4

When a person is aware of their breathing, they make a decision as to whether it is normal or inappropriate. Explain this

Normal would be as a result of exercise whereas breathlessness at rest is deemed inappropriate.

5

Is ventilatory work mainly inspiratory or expiratory?

Inspiratory

6

What are the two components that make up ventilatory work?

1. Stretching work = elastic work
2. Airflow work = resistive work (friction of air)

7

What is the difference between restrictive and resistive?

Resistive is the friction caused by air flowing through the airways and is very small (negligible)

Restrictive work is affected by inflammation and fibrosis of the interalveolar septa

8

What is the difference between restrictive and resistive?

Resistive is the friction caused by air flowing through the airways and is very small (negligible)

Restrictive work is affected by inflammation and fibrosis of the interalveolar septa

9

What is the total body of work?

The drive (metabolic activity) that are a combination of the multiple stimuli to breathe

10

What is the total body of work?

The drive (metabolic activity) that are a combination of the multiple stimuli to breathe

11

What are the two approaches to diagnosing dyspnoea?

Physiological: Increased Load and/or an Increased Drive leads to the shortness of breath

Clinical approach: patients risk factors, presentation and associated features, clinical signs and from this to an organ directed test

12

What body systems can cause dyspnoea?

Respiratory
Cardiac
Muscle weakness
Metabolic (eg. acidosis)
Anaemia
Pyschogenic

13

What are the main respiratory causes of dyspnoea?

1. Airways disease (upper vs. lower)
2. Alveolar disease
3. Pulmonary vascular disease
4. Pleural and chest wall disease
5. Respiratory muscle disease

14

What are associated signs that can help narrow the diagnosis to an airways disease?

The presence of wheeze or stridor suggests an obstruction or abnormalities with the airways
(another small sign is the presence of sputum)

15

What would hint to a clinician COPD or emphysematous disease? How would you confirm this?

Smoking history
CT scanning and Spirometry

16

What do crepitations suggest in terms of diagnosis?
What does the timing tell?

A problem with the alvoelar air spaces
Crepitation is the sound of the spaces 'popping' back open suddenly

Early inspiratory = air being forced through fluid in the alveoli and terminal bronchioles (oedema)
Late inspiratory = interstital lung disease and scarring

17

What do crepitations suggest in terms of diagnosis?
What does the timing tell?

A problem with the alvoelar air spaces
Crepitation is the sound of the spaces 'popping' back open suddenly

Early inspiratory = air being forced through fluid in the alveoli and terminal bronchioles (oedema)
Late inspiratory = interstital lung disease and scarring

18

What do crepitations suggest in terms of diagnosis?
What does the timing tell?

A problem with the alvoelar air spaces
Crepitation is the sound of the spaces 'popping' back open suddenly

Early inspiratory = air being forced through fluid in the alveoli and terminal bronchioles (oedema)
Late inspiratory = interstital lung disease and scarring

19

What does pleuritic pain suggest?

The pleura are involved in inflammation
A common presentation of pulmonary vascular disease

20

What is exercised induced bronchoconstriction (Asthma)?

In young athletes, 30-40% experience this and this is likely due to the chronic hyperventilation they experience with their levels of exercise (high airflow) leading to sheer damage on the airways