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Dyspnea Grade your dyspnea

Reviewed by
Dr. Pradip Chauhan

Definition

Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioral responses

Etiology

Pulmonary disorders

Obstructive lung diseases
- asthma
- bronchitis
- chronic obstructive condition
- cystic fibrosis
- emphysema
- hookworm diseases
Diseases of lung parenchyma and pleura
- Contagious
  - anthrax through inhalation of bacillus anthracis
  - pneumonia
- Non-contagious
  - fibrosing alveolitis
  - atelectasis
  - hypersensitivity pneumonia
  - interstitial lung disease
  - lung cancer
  - pleural effusion
  - pneumoconiosis
  - pneumothorax
  - non-cardiogenic pulmonary edema or acute respiratory distress
- Pulmonary vascular diseases
  - Acute or recurrent pulmonary emboli
  - Pulmonary hypertension, primary or secondary
  - Pulmonary veno occlusive diseases
  - Superior vena cava syndrome

Mechanism

general, dyspnea signals that there is inadequate ventilation. This happens when the body is unable to ventilate enough to sufficiently meet the body's needs. This situation may occur when there is increased ventilatory demand (e.g. during exercise) or reduced ability to ventilate enough (e.g. due to respiratory muscle weakness).

Degree of Dyspnea

Dyspnea can be a worrying and disabling symptom for the patient. In order to assess the level of dyspnea, the doctor might ask the patient to rank the severity from 1 to 10. Alternatively a scale such as the MRC Breathlessness Scale might be used - it suggests five different grades of dyspnea based on the circumstances in which it arises.

Grade	Degree of dyspnea
0	no dyspnea except with strenuous exercise
1	dyspnea when walking up an incline or hurrying on the level
2	walks slower than most on the level, or stops after 15 minutes of walking on the level
3	stops after a few minutes of walking on the level
4	dyspnea with minimal activity such as getting dressed, too dyspneic to leave the house

Some studies have suggested that up to 27% of people suffer dyspnea,while in dying patients 75% will experience it.

Prognosis

People with SOB make up about 7% of people who present to the emergency department in the United States. Of these approximately 51% are admitted to hospital and 13% are dead within a year.

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