• Shortness of breath
    Breathing is a natural and obvious process - until difficulties are encountered. What is shortness of breath? What are the causes of respiratory disorders? How to treat shortness of breath, and how to prevent flare-ups?

    Most people see the air as an available and obvious resource, and even if many of us are concerned about rising air pollution - we can still breathe freely, and the concept of "hunger for air" is strange for us.

    Breathing is an automatic process that is usually done without our paying attention to it, although we can control it. Breathing is done at a steady pace - slow at rest and fast in effort. From time to time we take a deep breath that changes the rhythm. We do that too, usually, without being aware to it.

    What happens in the body during normal breathing?
    In normal and quiet breathing we inhale around 500-600 ml of air. The air passes through the nose and through the mouth to the upper airways (the trachea and the bronchi) and reaches the pulmonary alveoli, which are small bags in which the gas is exchanged between the air and the blood. The way from the nostrils and the lips to the pulmonary bladder is quite long, and at any stage of the road the free flow of air may go wrong.

    What is shortness of breath?
    Shortness of breath is a scary symptom for someone who has experienced it for the first time. This is a situation in which there is an objective or subjective disturbance in the routine and automatic breathing process. Shortness of breath can manifest itself in symptoms (feelings one describes) or objective signs that can be observed.

    What are the signs of significant breathing difficulty?
    A person suffering from shortness of breath complains first of all that he can not breathe. He makes every effort, and in addition to the normal process of breathing, he uses accessory muscles and tries to breathe more air. Even in exhaling, he strained and pursed his lips. In severe respiratory distress, neck muscles are prominent, nasal nostrils are dilated, skin is very blue and the patient is perspiring.

    Can shortness of breath cause changes in behavior?
    The brain is immediately affected by lack of oxygen and the increase in the level of carbon dioxide (CO2). In an extreme situation, a person suffering from shortness of breath will appear bluish and will become agitated, confusied and sometimes even aggressive behavior.

    Can lying down relieve shortness of breath?
    On the contrary: when there is shortness of breath, it is hard to lie down. Sitting makes it easier to breathe because the diaphragm is lower and you can lift the ribs and increase the volume of the chest.

    Is there an accurate measure of shortness of breath?
    The most accurate and sensitive measure of breathing distress is the rate of breathing and breathing depth. An adult normally breathes 12-16 breaths per minute. The air would be inhaled for about two seconds, and after a pause of about a second he would breathe slowly. During this time the fresh air enter the lungs, and the air that needs replacement is exhaled.

    If the breathing rate reaches 30 or 40 breaths per minute at rest, it is clear that something interferes with the breathing process.

    Breathing properly is a quiet, effortless process, but a person who suffers from shortness of breath tries very hard to inhale even a small amount of air into his lungs. He forces his chest muscles to try and increase the volume of his chest. He forces the muscles of the neck and his nostrils expand with each breath.

    What is the meaning of a slow pace of breathing?
    A very slow breathing rate of less than 6-7 breaths per minute indicates breathing suppression and is a significant warning sign. The rate is reduced mainly because of the effects of drugs on the respiratory center in the brain - usually powerful pain medication such as morphine. Brain injury and pressure created in the skull as a result of accumulation of blood or fluids can cause a decrease in respiratory frequency.

    Acute and chronic shortness of breath
    There are two types of shortness of breath: acute and chronic.

    Acute shortness of breath
    Develops rapidly, in minutes to days, and may be life-threatening. These are the common causes of acute shortness of breath:

    1. Bacterial infections, fungal infections and viral infections of airways and lungs. These diseases are accompanied by fever, cough, phlegm production, and restlessness.

    2. A severe allergic reaction that results in anaphylaxis occurs shortly after exposure to a certain substance (medicine, food, etc.) and is usually accompanied by itching, swelling of the skin and the hoarseness. These emergency situations require immediate treatment by administering an adrenaline shot and steroids. 

    3. Acute flare-up of asthma and COPD (see below).

    4. Sudden blockage of the airways due to the inhalation of a foreign body (grain, coin, food, etc.).

    5. Pulmonary Embolism which causes partial or total blockage of the pulmonary arteries.

    6. Spontaneous or traumatic Pneumothorax which causes a collapse of the affected lung, as a result of the accumulation of air between the two layers of the lung membrane.

    7. Pulmonary edema - The result of sudden damage to the heart muscle (acute infarction, arrhythmia, extreme blood pressure) is caused by fluid leakage from the pulmonary blood vessels and their accumulation in lung lobes. This causes an imbalance in the oxidation level and requires treatment of the cause of the edema that usually leads to the administration of medications through the vein, in addition to oxygen and morphine.

    Chronic shortness of breath
    Develops slowly and causes long-term complications:

    1. Uncontrolled bronchitis (asthma).

    2. Obstructive pulmonary disease (COPD).

    3. Heart Failure 

    4. Fibrostatic diseases of the lung. In this group of diseases, the healthy tissue of the lung is damaged and replaced by an ineffective fibrotic (scar) tissue. The result is shortness of breath and and increased pulmonary ateries blood pressure.