dyspne

Dyspnea, or shortness of breath, is a subjective sensation of breathing discomfort. It can range from mild to severe and may occur acutely or develop gradually over time. It is a symptom rather than a disease, arising from a variety of conditions affecting the lungs, heart, blood, muscles, or nervous system, as well as from deconditioning or anxiety.

Causes and pathophysiology: Dyspnea results when the respiratory system cannot meet metabolic demands due to increased work of breathing, reduced ventilatory capacity, or impaired gas exchange. Common etiologies include heart failure, chronic obstructive pulmonary disease, asthma, pneumonia, pulmonary embolism, interstitial or other interstitial lung diseases, anemia, obesity hypoventilation syndrome, deconditioning, neuromuscular disorders, chest wall disorders, and anxiety. Acute dyspnea may signal a life-threatening process and requires rapid assessment.

Evaluation: In suspected serious cases, urgent assessment focuses on airway, breathing, circulation, and identifying reversible etiologies. Baseline data include vital signs and oxygen saturation, with a focused history and exam. Investigations are guided by clinical suspicion and may include chest imaging, electrocardiography, complete blood count, arterial blood gas, and targeted tests (BNP, troponin, d-dimer) as appropriate.

Management: Treatment targets the underlying cause and any immediate risks. In emergencies, ensure airway and provide supplemental oxygen to maintain adequate saturations; administer bronchodilators for obstructive disease, diuretics for fluid overload, antibiotics for infection, and anticoagulation for suspected thromboembolism as indicated. Nonpharmacologic measures include breathing techniques, pulmonary rehabilitation, vaccination, smoking cessation, and weight management. Chronic dyspnea management emphasizes disease-specific therapies, optimized supportive care, and, when appropriate, palliative approaches.