Friday, September 29, 2023

Breathlessness – Asthma or Something Else?

On 27 May, 2023, Seniors Today hosted their weekly Health Live Webinar with Dr Aditya Agrawal, a Seniors Pulmonologist who spoke on and answered questions about “Breathlessness- Asthma or Something Else?”

About Dr Aditya Agrawal

Dr Aditya Agrawal is a leading Consultant Pulmonologist attached to several large hospitals in Mumbai. He is extensively trained in respiratory diseases both in India and the US. His special interests are in difficult-to-treat cough, asthma, bronchitis and lung fibrosis, and runs a specialised clinic for patients with chronic cough. He is a dedicated researcher and a peer influencer in the management of respiratory diseases.

Breathlessness is a subjective experience of breathing discomfort that qualitatively distinct and varies in intensity.
This means that every person will have a different experience of breathlessness which is basically breathing discomfort which will be different in intensity with each person and it will be different in the way a person experiences and feels it.
Breathlessness and its intensity is multifactorial. There are multiple physiological, psychological, social and environmental factors that will determine how breathless you are.

Perception is the way we interpret any sensation and so is the case with breathlessness. So, depending on how we perceive breathlessness, will we be able to interpret how breathless we are. There is a complex neuro-cognitive process involved which involves how you are receiving the signal, and this will tell you how breathless you are and then, this is processed in the brain to help you externally exhibit how breathless you will be. This takes into account several parameters such as- our past experiences, our mood and the environmental cues.
How we perceive breathlessness relates to a range of multifactorial complex influences.

It depends on what is happening in your lungs, respiratory muscles, the tubes that take the air from the outside to your lungs. It is also determined by the central and peripheral chemoreceptors- the receptors which help you understand the subtle changes in the body. They all take signals to the brain which processes the information and sends out these signals to the body which in turn translate into breathlessness.

Descriptors of breathlessness:
Rapid breathing
Difficulty in breathing out completely
Shallow breathing
More effort required in breathing
Not getting enough air
Suffocating symptoms
Chest tightness/ constriction
Sudden stoppage of breathing
Gasping for air/ choking
Tightness in throat

Any time you have any of these symptoms, it means that you are breathless and you need medical aid/ help.

Anytime that you have breathlessness, you should see a doctor and have it treated.

A medical emergency would be:
When you are very breathless even at rest
Severe breathlessness with chest pain- may indicate that you are having a cardiac disorder such as a myocardial infarction also known as heart attack
Pneumothorax- air filled in the lungs
Severe breathlessness with an allergic reaction, where you feel checked with or without swelling over your face, lips, etc. this is called an anaphylactic reaction
Assessment of a patient with breathlessness involves looking for the following:
Onset- sudden or chronic
Progression of breathlessness
Grade of breathlessness
Associated symptoms such as cough, wheeze, palpitations, sweating, chest pain and several more

You can say that you are NOT breathless when:
Somebody is not troubled by breathlessness unless he is doing strenuous exercise which he is not accustomed to.

Grade I Breathlessness: breathlessness on walking fast or walking on an inclined road, climbing flights of stairs

Grade II Breathlessness: walking on level ground, where you are walking slower than usual/ slower than your peers/ have to stop for breath after 15 mins

Grade III Breathlessness: you have to stop after walking 100m or a few minutes

Grade IV Breathlessness: difficult to leave home or breathlessness while performing day-to-day activities such as combing your hair or any activity involving your hands above your shoulder.

Causes of breathlessness:
Lung diseases
Chemical factors, like your blood having more acid or alkali which can cause breathlessness
Adaptation to new exercise regime
Lack of physical activity- physiological breathlessness
Problems in your vocal cords and larynx
Nasal obstruction
Heart associated diseases- vascular disorders, pericarditis, myocardial infarction, cardiomyopathies, vernacular hypertrophy
neuromuscular disorders
Metabolic acidosis
End stage diseases such as cancers

We will focus on the lung causes. This can be due to
Pulmonary embolism
COPD- Chronic Obstructive Pulmonary Disease
Disorders of pleura
Cystic fibrosis- complex genetic disease, more common in white population
Lung cancer
Pulmonary oedema
Pneumothorax Sarcoidosis and lung fibrosis
Pneumonia, tuberculosis
Pulmonary hypertension

Asthma can cause constriction of the muscles surrounding the lungs which constrict thereby reducing the air passing through these tubes due to the constriction. Large amount of mucus is also formed. All of this leads to difficulty in breathing.

Majority of individuals have asthma due to allergies, complicated or associated with asthma. Asthma is a very common condition and very commonly misdiagnosed.

Asthma can present as the following, apart from breathlessness:
Triggered by an external stimulus
Chest tightness

Difficulty in breathing in a lying position is a very common symptom often seen associated with heart diseases. This can be due to lack of blood supply to the heart or due to valvular heart disease. It is also commonly seen in patients with high blood pressure, damaged heart muscles, aerial fibrillation, mitral valve disorders.
This occurs because the pressure on the heart increases suddenly and there is a severe fall in the oxygen levels during sleep.
These patients present with the complaint of difficulty in sleeping on their back and say that they prefer sleeping on several pillows under them/on their sides.
These patients also complain of breathlessness that improves on sitting or standing.
Wheezing is also a common complaint. Cough and chest pain can also be present.

Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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