Subjective and objective shortness of breath
Shortness of breath is a violation of the frequency of the rhythm, as well as the depth of breathing. In this case, a person experiences a feeling of lack of air, it is difficult for him to breathe deeply. Doctors distinguish between subjective and objective shortness of breath.
Content:
- What is subjective shortness of breath?
- What is Objective Dyspnea?
- What is mixed dyspnea?
- Diagnostics
- Treatment
What is subjective shortness of breath?
Subjective dyspnea is manifested in the fact that a person experiences difficulty breathing, but at the same time there are no objective signs of a change in his depth, rhythm and frequency.
Subjective shortness of breath can accompany neuroses, neurocirculatory asthenia and hysterical seizures. Such shortness of breath is also called respiratory neurosis. It has been proven that about 80% of patients suffering from neuroses and hysteria periodically experience changes in the respiratory rhythm.
Control of the human respiratory system is carried out with the help of the brain. Disturbances in the functioning of the nervous system, stress and hysteria - all this leads to failures in the work of a single well-coordinated mechanism. The respiratory center begins to send too frequent nerve impulses along the nerve fibers to the diaphragm and the muscles responsible for the work of the chest. It often happens that the brain remembers the circumstances in which a person had subjective shortness of breath. Subsequently, he reproduces them in a similar situation. For example, if the first attack of shortness of breath occurred in a person during a trip in the subway, then the next time you descend into the ground, it may recur.
The reasons for subjective shortness of breath can be as follows:
- Neurological and psychological diseases.
- Instability of the psyche.
- Frequent stress.
- Disorders in the work of the autonomic nervous system, including neurocirculatory dystonia.
- Drug overdose.
- Influence of toxic substances on the body.
Subjective dyspnea can be acute or chronic.
When a person develops an acute form of shortness of breath, it will be accompanied by the following symptoms:
- The man begins to choke.
- He has a hysterical fit, or he is at the peak of emotional stress.
- The patient requires others to immediately call an ambulance, can threaten death.
In an acute period, a person actually thinks that he can die from a lack of air.
As for the chronic form of the disease, shortness of breath will bother a person from time to time when he is in a stressful situation. As the underlying pathology progresses, the patient develops new complaints.
Subjective shortness of breath is not the only symptom of neuroses and mental illnesses. In addition to respiratory disorders, the patient often has diarrhea during periods of exacerbation, he suffers from a deterioration in appetite, and he is tormented by thirst. Painful sensations may occur in the chest area and under the left shoulder blade. The patient's limbs are trembling, there is general muscle weakness. The patient may feel dizzy, fingers numb, and goosebumps run. The person becomes irritable, has difficulty falling asleep.
During an acute attack of subjective shortness of breath, the patient may begin to cough violently, his breathing becomes intermittent, he complains of a lump in his throat.
Another pathology that is often accompanied by subjective dyspnea is cardiac-type neurocirculatory dystonia. In addition to breathing disorders, the patient may have increased heart rate, chest pains appear on the left side. The reason for the development of such a state can be very diverse.
This includes:
- Postponed acute and chronic infections.
- Nervous exhaustion.
- Received mental trauma.
- Stay in conditions of increased vibration, in the heat.
- Serious inaccuracies in nutrition.
- Alcohol and tobacco addiction.
- The period of puberty, accompanied by the immaturity of the mechanisms of regulation of the neuroendocrine mechanism.
In addition, in terms of the development of neurocirculatory dystonia, the fact of heredity is important.
Subjective shortness of breath in children
If the child periodically complains of choking attacks, and the parents notice that he suffers from shortness of breath while crying or psycho-emotional stress, the baby needs to be urgently examined.
Subjective shortness of breath in children may indicate serious disturbances in the functioning of the central nervous system and in the respiratory system. Other signs of impairment are mood swings, increased fatigue, and poor sleep quality. Children often wake up at night and may cry.
What is Objective Dyspnea?
Objective shortness of breath is a breathing disorder that is determined by all research methods. At the same time, a person does not experience subjective sensations. There is such shortness of breath in people suffering from emphysema of the lung. The patient himself ceases to complain of shortness of breath to the doctor, as he gets used to difficulty breathing.
Emphysema of the lungs is a chronic pathology that is accompanied by persistent expansion of the airspace and swelling of the lung tissue. Such changes are irreversible.
The following reasons lead to the development of the disease:
- Congenital alpha-1 antitrypsin deficiency.
- Smoking.
- Poisoning with toxic substances.
- Disturbances in the functioning of small vessels that feed the lung tissue.
- Bronchial asthma.
- Inflammation of the bronchi and alveoli.
- Work in industries where a person is forced to breathe polluted air.
The lungs of a person suffering from emphysema increase in size. In appearance, they may resemble a sponge.
Patients with pulmonary emphysema suffer from shortness of breath. It appears during physical exertion, and as the pathology progresses, it begins to bother the person at rest. To compensate for the lack of breathing, a person begins to breathe in a special way. He closes his lips and simultaneously puffs out his cheeks, as if "puffing". Getting used to breathing in this way, the patient ceases to notice the symptoms of shortness of breath, while it will be obvious to the doctor and even to the people around him. Therefore, it is called objective.
In addition to shortness of breath, a person with emphysema will be bothered by a cough, which is accompanied by the release of a small amount of sputum. The patient's face becomes puffy, the veins of the neck increase in size, the skin is cyanotic.
What is mixed dyspnea?
With mixed shortness of breath, the patient has both objective and subjective signs of shortness of breath. It is found in various diseases of the respiratory system, heart and blood vessels, as well as in other pathologies.
Diagnostics
Subjective dyspnea is the symptom for which it can be difficult for a doctor to make a correct diagnosis and associate this fact with disorders in the functioning of the nervous system. Most often, the exception method comes to the rescue.
If there is a possibility and specialized equipment, then it is necessary to perform capnography. During the study, it is possible to measure the concentration of carbon dioxide that a person exhales.
One of the most effective methods for diagnosing neurological disorders is a detailed conversation with the patient. The doctor must carefully analyze his complaints, clarify the severity of shortness of breath and find out in what situations it manifests. The Naymigen questionnaire can be used to diagnose such violations. It was developed by Dutch pulmonologists.
Diagnosis of neurocirculatory dystonia is reduced to a thorough analysis of the patient's complaints and monitoring him for several months. As a rule, a person indicates not only shortness of breath, but also sleep disturbances, anxiety and irritability. Complaints are multiple. It is often possible to trace the relationship between attacks of subjective shortness of breath and stressful situations, or periods of hormonal changes.
Objective dyspnea differs in that the patient himself does not notice it, but the doctor clearly sees its signs. In addition, the doctor notes the barrel-shaped shape of the patient's chest, widened intercostal spaces, shallow breathing with the involvement of auxiliary respiratory muscles in this process.
A patient with suspected emphysema is prescribed an x-ray of the lungs, blood donation for biochemical analysis, CT of the lungs, spirometry.
Treatment
The treatment of subjective shortness of breath that occurs against the background of nervous disorders should be dealt with by a doctor who has experience working with patients with mental disorders. If therapy is absent, then this can lead to the progression of psychological failures, to a decrease in the patient's quality of life. As a rule, such patients are always in fear of a new attack of shortness of breath, fearing to die from it.
The treatment regimen should be determined on an individual basis. It all depends on the specific symptoms and their severity. Treatment is based on psychotherapy sessions. You shouldn't take them lightly. Working with a therapist reveals the root of the problem.
Breathing exercises also help patients. Exercises are designed to reduce the depth of inhalation and exhalation, to increase the content of carbon dioxide in the blood, since during an attack the concentration of this substance in the body decreases.
The patient must follow the daily routine, eat right, maintain physical activity. It is important to give up bad habits.
If the pathology has a severe course, and exacerbations occur often, then the person is prescribed a drug correction.
He can take the following medications:
- Herbal sedatives.
- Antidepressants and tranquilizers designed to reduce anxiety.
- Vitamin D and magnesium, which relieve excessive tension from the muscles responsible for the movement of the sternum.
- Beta-blockers.
Another recommendation that allows you to quickly cope with an attack of subjective shortness of breath and nervous tension is breathing in a bag. Such a measure will increase the level of carbon dioxide in the blood and the human condition will improve.
Treatment of neurocirculatory dystonia should be based on non-drug methods. The patient is recommended to go in for sports, temper, observe the regime moments. A visit to a psychotherapist is mandatory.
The positive effect can be achieved by methods of physiotherapy. You can cope with the problem by taking medicinal baths, it is good if you can practice electrosleep. Also, the patient must perform exercise therapy. For sleep disturbances, motherwort or valerian can be taken. In general, the treatment of neurocirculatory dystonia has something in common with the treatment of neuroses, hysteria and other mental disorders, which may be accompanied by the occurrence of subjective dyspnea.
In case of pulmonary emphysema with objective shortness of breath, treatment should be aimed at eliminating pathological symptoms. There is no specific therapy. The patient is prescribed bronchodilators in the form of tablets and in inhalation until the end of his life. These can be drugs such as Salbutamol, Fenoterol, Theophylline, etc. Also shown is the use of glucocorticosteroids, for example, Prednisolone.
Against the background of developing heart and pulmonary failure, the patient is prescribed diuretics, oxygen therapy is performed. The patient must definitely perform breathing exercises. Severe cases require surgery to reduce lung volume. However, only organ transplantation will help to cope with the disease.
Subjective and objective shortness of breath are two symptoms that characterize completely different pathologies. If they are found, it is necessary to consult a doctor and receive treatment.
The author of the article: Molchanov Sergey Nikolaevich | Cardiologist
Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".
