DYSPNEOEA

BY: GROUP B2

Respiratory

SCENARIO 2
A man, 25 years old, with well-nourished, came to a
clinician with complaining of shortness of breath, fever
with temperature of 38.7c, and also coughing with
purulent sputum mixed with blood which has occur in
one week. Before this, he had sneezing and chest pain.
The attack of breathlessness are frequent and followed
by an excessive sweat, especially at night, and relief
without medication, but this time, even with drug intake,
the level of dyspnoea is increased.

Respiratory system

KEYWORDS

Man, 25 years
Well-nourished
Shortness of breath
Low grade fever
Cough
Purulent Bloody sputum
Sneezing
Chest pain
Night sweat
Recover without medication
Worsen when takes medicine

QUESTION
1.
2.
3.
4.
5.
6.
7.

What diseases causing dyspnoea

Etiology of associated disorder
Pathomechanism of each disease associated
Pathomechanism of the clinical manifestation
Investigations
Treatment
Prevention

Breathlessness or dyspnoea is a difficulty or distress in

breathing and a symptom of many different disease.

Exercise
PHYSIOLOGICAL

High attitude

Respiratory disorders
PATHOLOGICAL

Cardiac disorders
Obesity
Anemia

PSYCHOLOGICAL

Anxiety (Hyperventilation)

Drug induced respiratory disorder

PHARMACOLOGICAL Drug induced cardiac disorders

RESPIRATORY DISORDERS
ASSOCIATED WITH DYSPNOEA

Asthma
Pneumonia
Tuberculosis
Cystic fibrosis
Bronchitis
Bronchiectasis
Emphysema
Pneumothorax
Pleural effusion

DIFFERENTIAL DIAGNOSE
TUBERCULOSIS
BRONCHIECTASIS
CHRONIC BRONCHITIS

TUBERCULOSIS
Definition:
Infectious disease cause by Mycobacterium TB.
Worlds leading cause of death from a single infectious
disease.
Prevalence is on the increase, primarily due to the arrival
of Human Immunodeficiency Virus (HIV).
Causative agent: M.TB
Transmission: through the air or direct contact.

Respiratory system

CLINICAL MANIFESTATION

Coughing > 3 weeks (with / without sputum)

Haemoptysis
Dyspnoea
Chest pain
Low grade fever
Anorexia
Malaise
Night sweat

PATHOMECHANISM
MTB enter via respiratory route
Enter into lung
Fagosed by macrophage

IL-1,IL-2,IL-6,TNF ,

TNF-

prostaglandin

Cachectin factor

Blood circulation
Anterior hypothalamus
cAMP
thermoreceptor

Affecting feeding centre

Loss of appetite
Weight loss

IL-1,IL-2,IL-6,TNF ,
prostaglandin
Irritating to the
epithelium trachea
Vagal nerves

brain

Deep inspiration 2.5 lt

Body temperature
Low grade fever

Body sweating in
order to temperature

Transported thru the

lymphatic-blood to
body
Hilar lymph node enlarge

lymphadenopathy
Night sweat

Glottis closed
Abd.Muscle contract the
diaphragm
Intrathoracic pressure
Sudden open glottis
Rapid + force air expulsion
Chronic dry cough

If MTB cause erosion

of blood vessels
Haemoptysis

If immune response:
Mucous+pus+Cell debris
Sputum

DIAGNOSTIC APPROACH
1.

2.
3.
4.
5.

Sequential sputum samples are taken:

Stain with Ziehl-Neelson stain for acid-fast and
alcohol-fast bacilli.
Culture on Lowenstein-Jensen medium, which takes
up to 8 weeks.
Chest radiographs show upper zone shadows and
fibrosis.
Bronhoscopy is useful if no sputum is available.
Biopsies from pleura, lymph nodes and solid lesions
within the lung may be necessary.
Tuberculin test
Mycobacterium TB

Chest radiograph showing left upper lobe cavity

Respiratory system

TREATMENT
Antituberculostatic drug (6 months in two phase)
initial phase lasting two months (Rifampicin,
Isoniazid, Pyrazinamide plus streptomycin or
Ethambutol)
Continuation phase lasting 4 months (Isoniazid and
Rifampicin)
Patients should regularly followed up because lack of
compliance is a major reasons for treatment failure.
Direct Observe Therapy Short-course (DOTS).

BRONCHIECTASIS
Definition:
An abnormal and permanent dilatation of the bronchi and
is associated with chronic infection.
Etiology:
Acquired: Severe childhood infection (infection can
damage and weaken the bronchial wall, leading to
dilatation. (e.g. Postpneumonic,measles & TB)
Congenital: Kartageners Syndrome
Recurrent infections: immunoglobulin deficiencies
(e.g. IgA)
Major Pathogens: Staph.Aureus, H.Influenza.

Respiratory system

CLINICAL MANIFESTATION

Cough with copious purulent sputum (3 layer)

Halithosis sputum (foul smelling)
Recurrent Haemoptysis
Dyspnoea
Intermittent fever
Malaise
Weight loss
Clubbing fingers

PATHOMECHANISM
Multiple etiologies
Mucous stagnation
Bacterial infection
pneumonia
Fluid filled lung
Stiff lung
Dyspnoea

Mucosal bleeding
Haemoptysis

Bronchial irritation
(cough)

Stimulate monocyte
& macrophage

sputum
superinfection
Foul smelling
sputum

Halithosis

IL-1,IL-6,TNF
Anterior hypothalamus

Thermoregulatory
set point
fever

Respiratory system

INVESTIGATIONS
Radiology:
Chest radiograph may be normal or show bronchial
wall thickening.
Honey comb appearance; representing dilatation of
bronchi.
High resolution CT-scan; the investigation of choice to
detect bronchial wall thickening.
Sputum test
Gram stain, aerobic and anaerobic
culture,and sensitivity testing are vital.
Blood test; leukocytosis, anemia.

TREATMENT
Aims of treatment:
Control of infection;
antibiotics depend on infecting organisms.
Removal of secretion;
Postural drainage,10 20 minutes,3 times a day.
Bronchodilators
Mucolytic and Expectorant.
Surgery in selected cases.

CHRONIC BRONCHITIS
Bronchitis is an inflammation of the air passages
between the nose and the lungs, including the windpipe
or trachea and the larger air tubes of the lung that bring
air in from the trachea (bronchi).
Chronic bronchitis is defined clinically as a persistent
cough with sputum production for at least 3 months of
the year for two consecutive years.
Etiology: smoking, atmospheric pollution, chemical
fumes, environmental irritants; such as molds or dust.
The disease is strongly associated with cigarette
smoking.

Respiratory system

PATHOMECHANISM
Etiology
Persistent irritation of bronchial muscle
Hypersecretion of bronchial mucous glands
Hypertrophy of mucous glands &
increased number of goblet cells
Mucous production

Respiratory system

Mucous production
Regular expectoration of sputum
Productive cough

Airway obstructed by mucous

Ventilation perfusion mismatch
V/Q mismatch

Infection in alveolus
Erosion of blood vessels
Haemoptysis

Hypoxia
Hypercapnoea
Stimulate respiratory
centre
Dyspnoea

Respiratory system

CLINICAL FEATURES

Productive cough
Increasing dyspnoea
Weight loss
Haemoptysis
Chest pain
Fever

DIAGNOSTIC APPROACH
Pulmonary function
A spirometer to measure the volume of air
entering and leaving the lungs. Volumes less
than 80% of the normal values indicate an
obstructive lung disease.
Chest X ray
- Hyperinflation, with large lung volumes, flat
hemidiaphragms,and increased in the
anterorposterior diameter.
- Prominent vascular lungs marking (dirty chest)

MANAGEMENT
Bronchodilator
combining drugs may be useful.
Antibiotics
-after there is a change in nature of their chronic sputum
production.
Corticosteroids
Degree of reversibility can be assessed by prescribing
2 weeks of prednisolone 30mg / day, with
measurement of lung function.
Long term domiciliary oxygen therapy.