dyspnoea

• sensory quality:

  work: impair respiratory muscle

  tightness: bronchoconstriction stimulation of airway receptor

  air hunger: increased drive to breathe
• symptoms:

  • loss of bucket handle movement
  • use of accessory muscle inspiration
  • increased respiratory rate
  • active expiration
  • audible wheeze
  • pursed lipped breathing
• chronic bronchitis:

  • chronic inflammation and fibrosis lead to airway narrowing, increase work of breathing

  emphysema:

  • loss of surface area for gas exchange cause hypoxaemia, increase drive to breath
  • loss of elastic recoil, air trapped in airway, lead to airway obstruction
  • hyperinflation lower flat diaphragm, reduced lung capacity, increase work of breathing
• respiratory muscle weakness caused by neuromuscular disorder, malnutrition, fatigue. shortened diaphragm reduced lung expansion.

  airflow is resisted due to COPD, asthma and retained secretion. elastic load is increased due to ILD, pulmonary oedema and rigid chest wall. loss of elastic recoil lead to airway collapse like emphysema
• test:

  • measure intensity and sensation of breathlessness using borg scale(0-10)/ VAS
  • measure level of distress using anxiety scale
  • measuring how dyspnoea using MRC scale (rate of disability)
• exercise tolerance:

  cardiovascular limitation: experiencing chest pain angina

  respiratory limitation: experience breathlessneses

  peripheral limitation: experience fatigue or weakness in muscle
• test assess exercise tolerance:

  ISWT: 10m shuttle walk, increased paced controlled by audio

  ESWT: intensity based on patient performance in ISWT

  6MWT: suit more severe patient

  check patient VO2 peak, aerobic capacity, exercise tolerance

  test assess QOL

  CRQ/ SGRQ/LCADL/HAD(mental)