Dyspnea

Dyspnea is a subjective complaint by the patient feeling or consciousness of difficulty in breathing concerning the rate, depth or rhythm. It is a symptoms that can be expressed as:

• Difficult of breathing
• Difficult or laboured breathing
• Undue awareness of breathing 
• Need to breath more
• Uncomfortable or unpleasant breathing

Grading of dyspnea:

Two scoring systems can be adopted to evaluate the dyspnea changing it from subjective complaint to objective event.

• American Thoracic Society Score (ATS)

Grade	Description
0	No breathlessness except with strenuous exercise
1	Breathlessness when hurrying on the level or walking up a slight hill
2	Walk slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at town pace on the level
3	Stop for breath after walking about 100 yards (96 meter) or a few on the level
4	Too breathless to leave the house or breathless when dressing or undressing

• New York Heart Association Score (NYHA)

Grade	Description
1	Dyspnea on more than ordinary activity
2	Dyspnea on ordinary activity
3	Dyspnea on less than ordinary activity
4	Dyspnea on rest

The interpretation of dyspnea includes the following points:

• Onset:-

1. Within minutes or hours [Acute, i.e. Dyspnea as in emergency] (Acute attack of Asthma, Pulmonary Edema, Tension Pneumothorax, Acute Massive Pulmonary Embolism, Pneumonia & Sizable foreign body Aspiration)
2. Within days or weeks (Cardiac Failure, Thrombo-embolic Disease, Pleural Effusion, Anemia & Hyperthyroidism) 
3. Within months or years (COPD & Pulmonary Hypertension)

• Course:-

1. Progressive (Interstitial Pulmonary Fibrosis, Pulmonary Hypertension, COPD, Cardiomyopathy)
2. Intermittent (Bronchial Asthma) 

• Relation to time:-

1. Nocturnal [At night] (Bronchial Asthma, Cardiac Asthma & Obstructive Sleep Apnea)

• Relation to posture:-

1. Orthopnea [On lying down] (Left Sided Heart failure, Acute Asthma, Mediastinal Syndrome, Tense Ascites, COPD, Bilateral phrenic nerve paralysis)
2. Platypnea [On upright position] (Multiple recurrent Pulmonary Emboli, Bibasilar Pneumonia, Bilateral Pleural Effusion, Bibasilar arteriovenous shunt & Pulmonary arteriovenous malformation)
3. Talepnea [On lying lateral side] (Unilateral Lung & Pleural Disease:- Unilateral Pleural Effusion, Tension Pneumothorax, Destroyed lung & Atelectatic-Consolidated Lung)

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspnea
6. Chest pain