Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2780_Библиотеки_им_академика_М_И_Перельмана

MasahitoOgasawara

Shortness of breath is a feeling of difculty in breathing, which may be a symptom of a serious illness, or it may be felt even in people without illness. Even healthy people may feel shortness of breath during mountain climbing or strenuous exercise. Shortness of breath is treated almost synonymously with dyspnea, a condition in which a person is unable to breathe properly. Shortness of breath is caused by the integration in the brain of sensory information from sensory receptors in the body (chemoreceptors, mechani­cal receptors in the lungs, pulmonary vascular receptors, and biochemical information from skeletal muscles) and the motor output system from the brain to the respiratory organs. When one of these pathways is disturbed, it is perceived as “shortness of breath.” When any one of these pathways is impaired, we become aware of “shortness of breath.” To be active without short­ness of breath, the respiratory, circulatory, and myo-metabolic systems must work in good bal­ance. When any one of these systems fails, short­ness of breath is felt. The nervous system, the endocrine system, the blood (especially red blood cells), and the autonomic nervous system, includ­ing mental problems, are also involved in short­ness of breath. When patients feel shortness of breath, they complain in various ways. Specically, patients often complain of (1) a sense of chest or respiratory obstruction, (2) the need to exert effort to breathe, (3) the desire for oxygen or to breathe, (4) the inability to take large breaths, and (5) the rapid and ragged breath­ing. If the patient complains of shortness of breath or dyspnea, arterial blood gas measure­ment, chest X-ray, electrocardiography, and hematology should be performed immediately. The Hugh-Jones classication (Table1.3) is fre­quently used to evaluate the degree of dyspnea, and is rated on a 5-point scale [3].

However, the mode of onset and concomitant symptoms are particularly important in the differ­ential diagnosis of shortness of breath and dys­pnea. In the idiopathic and paroxysmal form, pulmonary embolism, spontaneous pneumotho­rax, bronchial asthma, aspiration of a foreign body into the upper airway, inhalation of poisonous gases, acute myocardial infarction, and hyperven­tilation syndrome are considered. Acute and pro­gressive (onset within a few days) cases include acute pneumonia, pleurisy, acute heart failure, malignant tumor, diabetic ketoacidosis, metabolic acidosis due to acute renal failure, and acute exac­erbation of chronic obstructive pulmonary disease. In the chronic course, chronic obstructive pulmo­nary disease, diffuse panbronchiolitis, bronchiec­tasis, interstitial pneumonia, and psychological factors are considered. Concomitant symptoms include (1) presence of fever, (2) edema, (3) blood sputum, (4) chest pain, (5) sputum, (6) wheezing, (7) dry cough, and (8) easy fatigability.

TakujiKiryu

Wheezing is a “noise” produced when the airways are narrowed. In general, “Stridor”

of the cough, presence of infectious symptoms, medical history, medication history, and smoking history.

Fundamental treatment of the causative disease is the rst priority. In asthma/cough variant asthma, inhaled steroids and other agents should be used to reduce airway hyperresponsiveness, and long­acting beta-2 stimulants should be used to achieve adequate bronchodilation. In chronic obstructive pulmonary disease (COPD), smoking cessation is the rst priority. In bacterial infections, appro­priate antimicrobial therapy is expected to decrease the volume of sputum and reduce air­way irritation. Histamine H1 receptor antagonists are effective in atopic cough. Cough has the role of removing foreign substances and sputum, and it is not advisable to stop coughing unnecessarily with antitussive agents. On the other hand, coughing itself can stimulate the airways and cause further coughing, and severe coughing can cause physical exhaustion and muscle pain.

and chronic according to their duration. In wet cough, cough plays an important role in the removal of secretions from the airways. According to the duration, there are three types of cough: acute cough that is mild within 3 weeks, subacute cough that lasts 3–8 weeks, and chronic cough that lasts more than 8 weeks. The causative diseases are listed in Table1.4.

chial glands, goblet cells, Clara cells, type II alveolar epithelium, and other airway constituent cells. Physiologically, it protects the respiratory tract mucosa by removing ne particles (pollen, dust, etc.) in the air, along with ciliary movement of the respiratory tract.

Inammation of the lower respiratory tract accounts for the majority of sputum production, although inammation, tumor, and pulmonary congestion are common causes. Inammation is divided into infectious and noninfectious dis­eases, and infectious diseases include cold syn­drome, acute bronchitis, pneumonia, pulmonary tuberculosis, and pulmonary mycosis, in which microorganisms such as bacteria, viruses, tuber­cle bacilli, and fungi infect the lower respiratory tract, causing inammation and sputum produc­tion. The most common noninfectious diseases are bronchial asthma, chronic obstructive pulmo­nary disease (COPD), and bronchiectasis. Bronchial asthma tends to cause cough, sputum, and wheezing due to allergic chronic airway inammation, while COPD causes cough, spu­tum, and shortness of breath due to chronic air­way inammation caused by inhalation of toxic substances such as tobacco smoke. In COPD, chronic airway inammation due to inhalation of toxic substances such as tobacco smoke causes cough, sputum, and shortness of breath. In bron­chiectasis, part of the bronchi is dilated, and the dilated bronchi are chronically infected with microorganisms such as bacteria, and cough,