Worthiness of anything can be realized only when it goes out of order. Lung is no way exception, i.e., even though every one breathes round the clock, no one knows the worth / work of untiring lungs. But, when a problem arises in the lung to manifest symptoms (gasping for breath or taking deep breathe often, etc.), with the fear of life, every one�s consciousness will be with lungs only. Ancestors may say soul remains in chest, heart, brain, air, blood, etc., but for patients suffering with breathlessness, it remains in lungs. For them, quality of life depends on the functional ability of lung / respiration only.

Breathlessness is commonly meant for shortness in breathing or difficulty in breathing (inspiration or expiration). Medically it is termed as Dyspnoea. Every one might have felt the breathlessness by one or other time, i.e. after violent exercise, running for a prolonged period, climbing staircase, when getting overweight, etc. It occurs commonly for the need of more oxygen supply or as an indicative of imbalance in respiratory gases (oxygen and carbon-dioxide) or due to other illnesses.

incidences � Breathlessness can occur in any one in any of the time with triggers. Generally elderly people suffer with breathlessness with strain and degenerative (lung or other) disorders. Now-a-days due to pollutants, low immune power and recurrent uncontrolled infections, children also happen to suffer more with respiratory complaints and breathlessness. The incidences of having breathlessness are more with sedentary people and less with sportive and hard workers. Hefty / obese people also often suffer with breathlessness while climbing stairs or while attempting any strain.

pathology � Even though lung remains as an inner part of the body, it is exposed to the chemicals and pollutants as equal to the outer surface of the body, since one cannot avoid breathing atmospheric air. Pollution and improper attention to the disease in initial period can drag one to degenerative changes / structural damages of the lung and breathlessness.

Commonly breathlessness occurs due to lack of oxygen supply, airway obstruction / narrowing and airway inflammations. In case of inhaling irritants, respiratory centre in medulla (in brain) triggers lungs to cough out the irritant air and initiates respiration in faster manner to exhale every part of irritant air and inhale fresh air. The chemical receptor in the respiratory centre keeps on analysis of the carbon-dioxide load in the blood. If carbon-dioxide exceeds to alarming level, with increased metabolism of the body, it provokes the lung to breathe more and more fresh air. In extreme condition it may be felt as breathlessness.

Causes of Breathlessness � Breathlessness can be caused by variety of problems and breathlessness can also cause variety of problems. No one can predict the exact cause (unless otherwise it is physiological � running / climbing stairs, etc.) and label the disease without a detailed analysis. Even though nose, throat, trachea and lungs are involved in breathing process, breathlessness need not to be confined with them. It can also be due to various other diseases or disorders too - for example heart diseases, anaemia, liver failure, kidney failure, etc. Causes are commonly classified in the following way

• External factors
• Internal factors
• Psychological factors

External factors �

• Low or inadequate supply of oxygen � for example in high altitudes, poor ventilated rooms, in congested crowds, etc.
• Extreme of temperature
• Violent exercises (especially in cold temperature)
• Infections � bacterial / viral / fungal � causing cold and cough
• Bites of Insects / mites
• Allergic tendency or hypersensitivity or immune response of body to cause oedema of lungs.
• Drugs (due to sensitivity or allergy)
• Pollutants � dust, smoke (industrial or cigarette or of automobiles), pollens, furs of animals / birds, preservatives in foods, chemical irritants / acids,
• Aspiration of small foreign bodies (parts of toys, foods during deglutition, pins, etc) entering into upper or lower respiratory tract causing obstruction or cramps or irritations

Internal factors �

• Nose � allergic rhinitis, sinusitis, post nasal drip, nose block (nasal polyps), etc
• Throat � Laryngitis, Pharyngitis, Complaints of Vocal cord, Thyroid complaints, etc.
• Lung � Acute bronchitis, Chronic bronchitis, Emphysema (COPD - chronic obstructive pulmonary diseases), Asthma, Tuberculosis, Pneumonia, Bronchiectasis, Lung cancer, Pneumothorax, Pleurisy, Pulmonary oedema / hypertension, Pulmonary embolism, Cystic fibrosis, etc.
• Excessive secretions or mucous in nose, throat, sinuses and lungs
• Heart � Congestive cardiac failure (heart failure), Myocardial infarction (heart attack), Arrhythmias, valvular dysfunctions (stenosis or prolapse), etc
• Stomach � Reflux oesophagitis, hiatus hernia, etc.
• Blood � Anaemia
• Poor functions of other parts of body � for example liver failure, kidney failure, etc. with water retention and puffiness of the body
• Loss of body fluids / vitamins and minerals and weakness of body

Psychological factors - Stress, tension, fear, anger, anxiety and excessive laugh can cause or intensify the breathlessness. Moral support can bring the sufferer to peace and unruffled state. Some may also breathe unusually and may acts as if they are suffering with breathlessness to draw attention towards them.

Types of Breathlessness � Breathlessness may be for inhalation or exhalation. Pattern of breathlessness may also vary depending upon its causes and management. Normally, duration of inspiration will be twice that of expiration time. In case of obstruction it will be reversed.

Auscultation of breathing sounds (with stethoscope) can point out infection or obstruction site and provide clue to diagnosis. The common abnormal sounds are crepitations, rales, rhonchi, wheeze and stridor. The breathing sounds will get muffled or absent in case of reduced air flow to the parts of lungs, over inflation of lungs (emphysema) and due to fluid or air collection around lungs (pleurisy or pneumo thorax). Normally, bronchial breathing is heard over bronchus or trachea, broncho-vesicular breathing is heard over hilar area, and vesicular breathing is heard all over the chest and classically over axillary and scapular areas. The common abnormal breathing are

• Gasping for air often (with deep breathe) � occurring commonly with weakness, low BP, lowered sugar level, etc.
• Rapid breathing / Hyperpnoea / Shortness in breath / Shallow breathing � exercise, fever, cold, weakness, stress, etc.
• Wheeze (breath with whistling sound) � Asthma, cardiac asthma, etc.
• Stridor (short crowing sound occurring mostly during inspiration) � laryngeal tumours, vocal cord dysfunctions, oedema of epliglottis, etc
• Exertional dyspnoea (difficulty in breathing with movements or work or exercise) � weakness, low BP, lowered sugar level, etc.
• Nocturnal dyspnoea (difficulty in breathing in night) � heart failure
• Orthopnoea (mostly on lying / nocturnal) � heart failure, hiatus hernia
• Sleep Apnoea (getting up from sleep due to lack of breathe) � upper respiratory infection, heart failure, nasal polyp, etc.
• Snoring (difficulty in breathing with obstruction in nasal pathway) � nasal polyp
• Cheyne stokes breathing (abnormal pattern of breathing which often vary from Apnoea to Hyperpnoea) � common in brain damages, strokes and heart failures

(To be continued)

Doctor's Profile

Making a Healthier Tomorrow Dr S Chidambaranathan, Homeopathic Consultant Website: http://www.drcheena.in/ www.drcheena.com E-mail: drcheena@yahoo.com

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March 31st, 2008