“Doctor, I'm always out of breath!”
"Oh yes, but then again..."
Not an easy symptom
Short breath... a symptom not always easy to describe and to find “THE” cause!
Breathing comes naturally - No need to think about it
First, you should know that breathing happens naturally an average of 15 times per minute. It is controlled by the “medulla oblongata,” situated just below the brain.
We also have the ability to control our breathing. This voluntary control, for its part is located in the brain... As soon as we "forget" to breathe, the autonomous center of breathing takes over!
Several questions to be answered
Shortness of breath is a subjective symptom. In other words, you can feel it, but it cannot be measured. It can be perceived differently from one patient to another.
The doctor must clarify all this information when meeting with the patient. Questions, examinations and requests for exams will be discussed.
Some questions particularly help the health professional to gather information regarding how long the patient has been noticing his or her shortness of breath and its progression over time. Are there other accompanying symptoms such as coughing, fever, weight loss, or chest pain?
It is also necessary to describe in what circumstances the shortness of breath appears. Is it during intense work, sporting activities, climbing stairs, personal care or simply during talking?
It is important to note activities that you can not practice anymore or that you are doing with more difficulty because of shortness of breath.
Different levels of breathlessness
Once the information is known and analyzed by the doctor, he or she can classify the severity of the breathlessness in 4 categories, that is: with intense, moderate or light effort or at rest.
This classification is international and allows the physician to monitor the progress of symptoms of shortness of breath over time, noting its improvement, its stability or its deterioration.
In case of chronic illness, an increase in shortness of breath forces the doctor to re-evaluate the treatment and, in some cases, to request further examinations to confirm the progression of the disease and readjust the treatment.
Several possible causes
The origin of shortness of breath may be of different causes, even a combination of these. The reasons may be pulmonary, cardiac, related to physical deconditioning, or related to anxiety and ... aging.
In older people, the heart is not necessarily the cause but aging and poor physical condition may be the reasons for shortness of breath.
Deconditioning is not a disease but a condition. The benefits of regular physical activity can be seen quickly.
When the condition of the heart is responsible
When short breath is a consequence of a cardiac problem, either related to a malfunction of the heart muscle (heart failure), or linked to an excess of the amount of blood ejected (valvular insufficiency) or even linked to the combination of the two (often associated in heart failure), there is repercussion in the lungs.
When we breathe
Let's simplify this to better understand.
Breathing is inhaling oxygen from the air and exhaling the carbon dioxide from our body. These exchanges of oxygen and carbon dioxide take place inside 600 million small air bags called alveoli that form the lungs.
The microscopic blood vessels, called the pulmonary capillaries, line the outside of these microscopic bags. Their role allows for blood to release the carbon dioxide and quickly recharges with oxygen.
When the heart is sick
When the heart pumps with less effectiveness, the lung suffers from a build-up of water between the capillaries and these microscopic air bags.
Water in the breathing machine
If a larger quantity of liquid fills this space, the exchanges are affected. The oxygen level decreases in the blood and carbon dioxide accumulates. The portion of the brain responsible for breathing is stimulated and gives the sensation of being out of breath.
In most severe cases, this feeling is accentuated to actually run out of air.
The presence of this surplus liquid in the alveolo-capillary space stimulates small "sensors" situatied in the lungs.
These sensors send a message to the brain.
Even if the extra quantity of liquid is not sufficient to affect the exchange of oxygen and carbon dioxide, the brain responds by increasing the breathing, hence the feeling of shortness of breath.
Cough and respiratory screeching
A cough may also be present and a screeching sound when breathing resembling asthma may be heard.
Two other types of breathlessness
In addition to shortness of breath at different levels of physical activity, two other types of breathlessness are present when the heart is sick:
• Difficulty breathing when lying down. Patients add pillows under them to breathe better. In more severe cases, they sleep in a chair to avoid lying down.
• Difficulty breathing suddenly at night. Patients are awakened by severe shortness of breath. They must sit or even get up to let the shortness of breath fade away.
When sudden and rebellious shortness of breath occurs, you must go to the emergency room at the hospital.