1. DYSPNEA Menaldi Rasmin
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia Persahabatan Hospital, Jakarta

2. INTRODUCTION Dyspnea: Discomfort feeling in breathing
Subjective and difficult to measure
Etiology : lung, heart, endocrine, kidney, neurology, hematology, rheumatology and psichology
Prevalence of dyspnea → no accurate data 1

3. VENTILATORY REGULATION
Ventilatory Central Centre
located in the medulla of the brainstem
composed of several subcenters, that interact to produce rhytmical breathing
output is transmitted to phrenic nerves to diaphragm and respiratory muscles
affected by
Higher cortical centers
Mechanical
Chemical stimuli

4. Cortical Centers Mechanical reflexes input to the ventilatory center
result; breathing partially under voluntary control
Mechanical reflexes
emanate from skeletal muscle spindle
pulmonary vessels and tissue

5. Dyspnea breathlessness shortness of breath
uncomfortable or unpleasant respiratory-related sensation
not tachypnea, not hyperpnea and not hyperventilation but; difficult, labored, uncomfortable breathing; it is unpleasant type of breathing though not painful in the usual sense of the word. It is subjective and, like pain, it involves both perception of the sensation by the patient and his reaction to the sensation
Comroe (1966)

6. “ an uncomfortable awareness of breathing or an increased respiratory effort that is unpleasant and regarded as in appropriate” (Mahler et al 1984)

7. DEFINITION OF DYSPNEA The American Thoracic Society (ATS):
the term of discomfort perception subjective in breathing that consist of sensation with different intensity as a results of interaction of various physiologic, social and environtmental factors. 3

9. MECHANISM OF DYSPNEA
Interaction between signal and receptor in otonomic nerve system, motoric cortex,airway receptor, lung and thoracic cage →dyspnea 4

10. MECHANISM OF DYSPNEA Dyspnea Emosi Komplek pernapasan
Dispnea
Komplek pernapasan
Paru & dinding dada
kognitif
perilaku
Emosi
Stimulasi kemoreseptor
latihan
Kortek motorik primer
Kortek sensorik primer
MECHANISM OF DYSPNEA
Dyspnea
Complex of breathing
Lung and thoracic cage
Cognitive
Behavior
Emotion
Chemoreceptor stimulation
Exercise
Primary motoric cortex
Primary sensoric corte

11. MECHANISM OF DYSPNEA

16. MEASUREMENT OF DYSPNEA
Aim : to differentiate the severity and to evaluate the nature of dyspnea
Technique of measurement :
visual analogue scale
Borg scale
Medical Research Council (MRC) Dyspnea Scale
American Thoracic Sosiety (ATS) Dyspnea Scale
Baseline Dyspnea Index (BDI)
Transitional Dyspnea Index (TDI)

17. ATS dyspnea index Grade 1 : No dyspnea except severe exercise activity
Grade 2 : Dyspnea when climb the step
in hurry or climb a small hill
Grade 3 : Walk slower compared to
common people
Grade 4 : Must stop for breathing after
100 yard walk
Grade 5 : Dyspnea while put on / off
the clothes

18. pulmonary non-pulmonary
Dyspnea
pulmonary non-pulmonary
(cardiac)
*pulm edema *arrhythmias
*asthma/COPD *acute MI
*PE *myocardial ischemia
*pneumonia
*pneumothorax

19. DYSPNEA IN PULMONARY DISEASE
Abnormality of breathing mechanism, lung become more stiff, weakness of ventilation muscles.
Restrictive lung diseases.
Obstructive lung diseases.
Disturbance of lung diffusion.
Disturbance of lung perfusion.

20. RESTRICTIVE LUNG DISEASE
Lung : - atelectasis
- fibrosis
- lung tumour
- bullae
- lung abscess
Mediastinum : - mediastinal tumour
- cardiomegali
- pericardial effusion

21. ATELECTASIS

22. PANCOAST TUMOR

23. LUNG ABSCESS

25. DESTROYED LUNG

26. BULLAE

27. BULLAE

28. RESTRICTIVE LUNG DISEASE
Pleura : - pleural effusion
- pleural tumour
- pneumothorax
Diaphragm : - hernia of diaphragm
- paralize of diaphragm
Bone : - rib fracture
- pectus excavatum
- scoliosis, kyphosis
Muscle : - myasthenia gravis

29. PLEURAL EFUSSION

30. PNEUMOTHORAX

31. HYDROPNEUMOTHORAX

32. OBSTRUCTIVE LUNG DISEASE
Asthma
COPD : - Chronic bronchitis
- Emphysema
Bronchiectasis
Lung tumour
Foreign body

33. BRONCHIECTASIS

34. LUNG TUMOR

35. DISTURBANCE OF DIFFUSION
Alveolar wall
Interstitial space
Arterial wall
Plasma
Red blood cell wall

36. PNEUMONIA

37. ARDS

38. DISTURBANCE OF PERFUSSION
Pulmonary emboli
Congestive heart failure

39. LUNG NODULES

40. MILLIARY TB

44. CONCLUSION Dyspnea is a subjective symptom
Various abnormalities may cause
dyspnea
Severity of dyspnea can be measured

45. Thank You