Sometimes I feel difficult to breathe. What is the reason?

Dyspnea is an important symptom of respiratory insufficiency. Subjectively, patients feel that the air is insufficient, and objectively, they feel that they are struggling to breathe. In severe cases, flapping of the nose, cyanosis and sitting breathing will occur, and the auxiliary respiratory muscles will participate in breathing activities, and the frequency, depth and rhythm of breathing may be abnormal. At present, it is believed that dyspnea is mainly due to the need of ventilation, which exceeds the ventilation capacity of respiratory organs.

[etiology]

1. Respiratory diseases

Dyspnea caused by this kind of diseases is caused by respiratory diseases, such as poor lung ventilation and ventilation, decreased vital capacity, blood hypoxia and increased carbon dioxide concentration. There are three types of dyspnea caused by respiratory diseases:

(1) Inhalation dyspnea is caused by inflammation, edema, tumor or foreign body in larynx, trachea and bronchus. It is obviously difficult to inhale, the respiratory muscles are extremely tense when it is highly narrow, and the suprasternal fossa, supraclavicular fossa and intercostal space are obviously sunken when inhaling (called "three concave signs"), which may be accompanied by dry cough and high-pitched inspiratory wheezing.

(2) Exhaled dyspnea is caused by the weakening of lung tissue elasticity and bronchospasm stenosis. It is characterized by strenuous exhalation, long and slow exhalation, often accompanied by wheezing, which can be seen in chronic obstructive emphysema, bronchial asthma, spastic bronchitis and so on.

(3) Mixed dyspnea is caused by extensive lung diseases, which reduces the breathing area and affects the ventilation function. Patients feel hard to inhale and exhale, and their breathing frequency also increases, which can be seen in severe pneumonia, extensive pulmonary fibrosis, atelectasis, massive pleural effusion or spontaneous pneumothorax.

2. Heart disease

This kind of dyspnea is mainly caused by left heart or (and) right heart dysfunction, which is called cardiogenic dyspnea. It is characterized by the occurrence or aggravation of labor, relaxation or reduction at rest, aggravation of supine position and reduction of sitting position. Dyspnea caused by left ventricular dysfunction is more serious. Acute left ventricular dysfunction is often manifested as paroxysmal dyspnea, which often occurs in nighttime sleep and is called nocturnal paroxysmal dyspnea. During the attack, patients often wake up suddenly during sleep, feel stuffy or short of breath, and are forced to sit up. Mild symptoms disappear after a few minutes to dozens of minutes. In severe cases, asthma, wheezing, cyanosis, wet rales in both lungs, increased heart rate and pink foam-like sputum may occur. This paroxysmal dyspnea is called "cardiogenic asthma" and can be seen in hypertensive heart disease, coronary atherosclerotic heart disease (coronary heart disease) and so on.

3. Poisoning

In metabolic acidosis (uremia, diabetic ketosis), acidic metabolites in the blood strongly stimulate the respiratory center and produce deep and regular breathing, which may be accompanied by snoring, which is called acid heavy breathing. During acute infection, metabolism increases, blood temperature rises, and toxic metabolites in blood can stimulate respiratory center and accelerate breathing. When morphine and barbiturates are poisoned, the respiratory center is inhibited, resulting in slow breathing and tidal breathing.

4. Blood diseases

Severe anemia, methemoglobinemia, sulfide hemoglobinemia or carbon monoxide poisoning. It causes the oxygen carrying capacity of red blood cells to decrease and the blood oxygen content to decrease, resulting in slow and deep breathing and accelerated heart rate. In case of massive hemorrhage or shock, it can also cause dyspnea due to ischemia and blood pressure drop, and stimulate the respiratory center.

5. Neuropsychological factors

Severe brain diseases (such as cerebral hemorrhage, intracranial hypertension, craniocerebral trauma), due to reduced blood supply or direct pressure stimulation, the respiratory center is slow and deep, and changes in respiratory rhythm may occur. Hysterical patients may have dyspnea, which is characterized by very frequent breathing (up to 60 ~ 100 times per minute) and superficial symptoms. Due to hyperventilation, chest pain, respiratory alkalosis and tetany often occur. In addition, there is a sighing breath. Patients often complain of dyspnea, but there is no objective manifestation of dyspnea. The clinical feature is occasional deep breathing accompanied by sighing exhalation. Patients temporarily feel light after sighing and breathing, which also belongs to the category of neurosis.

Dyspnea is accompanied by the following symptoms, which has the significance of prompting diagnosis:

1. Paroxysmal dyspnea with asphyxia can be seen in bronchial asthma, cardiogenic asthma, fulminant eosinophilia syndrome, hysteria, etc. Sudden dyspnea can also be seen in glottic edema, tracheal foreign body, massive pulmonary embolism, spastic bronchitis, spontaneous pneumothorax and so on.

2. Dyspnea with unilateral chest pain can be seen in lobar pneumonia, pleurisy, spontaneous pneumothorax, tuberculosis, lung infarction, bronchial cancer, acute pericarditis, acute myocardial infarction, mediastinal tumor, etc.

3. Dyspnea with fever can be seen in pneumonia, pleurisy, tuberculosis, lung abscess, lung infarction, acute pericarditis, acute mediastinitis, central nervous system diseases, retropharyngeal abscess, etc.

[family emergency treatment]

1. Keep quiet to avoid emotional tension of patients, so as not to aggravate dyspnea.

2. Take a semi-recumbent position or sitting position to reduce fatigue and oxygen consumption.

3. Keep the indoor air fresh and ventilated.

4. The diet should be light, and patients should be encouraged to eat more fruits and vegetables to replenish water in the body.

5. Appropriate expectorant and antispasmodic drugs such as Shuangtang 8 ~ 16 mg, three times a day; Aminophylline 0. 1 ~ 0.2g, three times a day, to keep the respiratory tract unobstructed.

6. In critical condition, send to a nearby hospital for emergency treatment.