I Can't Breathe

 Dyspnea or Shortness of Breath

PKGhatak, MD

“ I can't breathe” has become a worldwide slogan for social justice after the killing of George Floyd in Minnesota.

I can't breathe, difficulty in breathing, sense of suffocation, air hunger, shortness of breath, short of wind, tightness in the chest, uncomfortable in breathing, not getting enough air, are some of the ways patients describe their difficulty - in medicine known as dyspnea.

The word dyspnea is derived from the Greek word dyspnoia – meaning breathing disorder.

The American Thoracic Society calls dyspnea” as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”

Can't breathe is one of the most frightening symptoms of human experiences. A sense of impending doom overshadows all other concerns. The patient fights with all his might to right the situation.

A healthy person may experience shortness of breath during strenuous exercise like climbing several flights of stairs or hiking mountains and visiting high altitude places.

Shortness of breath in all other cases is due to an abnormal condition/condition in the lungs or heart or neuropsychiatric causes.

Points to remember that dyspnea is subjective and varies in intensity.

When patients present with dyspnea the doctor categorizes them into groups according to 1. its severity. 2. episodic or chronic.

Some of the conditions of life threatening acute shortness of breath (SOB) are.

1. Allergic and anaphylactic. 2. Asthma. 3. Acute left ventricular failure (commonly called Pulmonary edema). 4. Cardiac tamponade (pericardial effusion or bleeding) 5. Rupture of the lung (pneumothorax). 5. Broken ribs and bloody pleural effusion 6. Pulmonary emboli. 7. Massive hemorrhage. 8. Choking. 9. Bilateral pneumonia like covid -19. 10. Carbon monoxide poisoning.

Chronic cases of SOB are 1. COPD. 2. Congestive heart failure. 3. Chronic anemia is secondary to systemic diseases. 4. Neuromuscular diseases like ALS, paralysis of the diaphragm, myasthenia gravis. 5. Morbid obesity. 6. Ascites. 7. Large intra-abdominal mass like Wilms tumor. 8. Chronic bilateral pleural effusion. 9. Interstitial pulmonary fibrosis. 9. Deformity of chest wall e.g. Kyphoscoliosis.10. Subphrenic abscess.11. Chronic illness or disability leading to deconditioning.12. Anxiety and psychosis.

Treatment:

The goal is to restore the normal functioning of the lung, heart, blood and brain as soon as possible.

Pulse oximetry is in wide use since the covid pandemic, it is the initial test and any lack of oxygen should be immediately corrected by giving oxygen.

The other conditions are just too many to discuss here. But the best place is the emergency room for severe acute situations and the doctor's office for non-life-threatening conditions.

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