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KMID : 0381219710030060431
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Journal of RIMSK
1971 Volume.3 No. 6 p.431 ~ p.442
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DYSPNEA
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Abstract
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1. Dyspnea is dyspnoia in Greek word which means difficulty of breathing or labored breathing.
Author described of the various abnormal breathing patterns which are polypnea, Tachypnea, Hyperpnea, dyspnea, acapnea, orthopnea, stridulous breathing, nachternal dyspnea, Cheyne-Stokes breathing, Biot´s Respiration, Kussmaul´s breathing etc.
2. The general considerations of dyspnea. The main function of respiration is to provide oxygen to the cells of the body & to remove excess carbon dioxide from them.
Large animals, including man, make use of two systems (1) a blood circulatory system to carry whatever is necessary to & from the tissue cells, with the help of a remarkable chemical, hemoglobin, which ensures the transport to large quantities of 02 & CO2 and (2) a respiratory system, a gas exchanger, to load the blood c 02 & remove excess C02, Respiratory system consists of two main parts: (1) a conducting airway, where practically no gas is exchanged (dead space), and (2) alveoli, where large amounts of 02 & CO2 are rapidly exchanged. Respiratory function provides a vast & extremely thin surface for the transfer of gases between air & blood. Man at rest requires a transfer of only 200^´250mL. Of 02/min., but during maximal exercise he may need more than 20 times this amount-up to 5, 500 mL. The surface area of the membrane available for this transfer is huge-about 70cm2, or 40 times the surface area of the body: it is less than 0. 1μ thick. Respiratory system is a breathing organ for the exchange of gases and circulatory system is blood pumping organ for the supplying of the oxygen, metabolic fuels etc, to every living cells of the organism. Prof. Cornroe defined of the pulmonary insufficiency which means the abnormal state of gases exchange in blood. In another words, the pulmonary insufficiency is the abnormal oxygenating or CO2 eliminating functions.
In state of 02 deficiency or abnormal CO2 eliminating conditions in blood where becomes of the disturbances of acid-base balance.
We can be seen of the two main etiological factors acid-base balance;
One is the abnormal blood gases exchanging state & the other one is disturbance of diffusion power.
3. We have to know the pulmonary function capacities on the various moments of breathing patterns.; such as tidal air (resting tidal volume), complementary air (inspiratory reserve), total capacity, supplemental air (expiratary reserve capacity), functional residual capacity, inspiratory capacity,
total lung capacity, vital capacity etc. Dyspnea and death space is always proportional. 4. Regulation of breathing.
Respiratory center & apneutic center, etc.:
The medullary center capable of initiating & maintain sequences of inspiration, expiration. The apneutic center in the middle and lower pons, that if uncontrolled, may produce prolonged, uninterupted inspiratory spasm or apneutic breathing.
The pneumotaxic center in the upper third of the pons that, along c the dominant vagal impulses, restrains the apneutic center periodically, hydrogenion concentration (H-`) gives the sensitive influence on the respiratory center.
Gesell believe that hydrogen ion concentration gives more sensitive influence on the cell: of the respiratory medullary center rather than the circulatory blood.
The body fluid´s acid-base balance is regulating under the rate of Hendersen-Hasselhalch equation
27mEq/L _
(normal PH.=6.1+log 1.35mEq;L -o´1+log20 =7.4) in physiological state.
This process has been regulating through the lungs, kidneys mainly.
Howell & Campbell have been advocating on the mechanism of dyspnea through their hypothesis of length tension inappropriateness which is getting to approve by many supporters.
And also described on the Hering-Breuer reflex, chemoreceptor (Carotid sinus & Aortic bodies) activities & Cheyne Stokes breathing as the regulation of breathings mechanism.
5. The outline showing conditions which may result in hyperpnea, dyspnea & orthopnea. This tablets help to make understanding of pathogenesis, & mechanisms in various clinical dyspnea patterns.
6. The sign of pulmonary insufficiency.
In broad meanings of dyspnea, we can be able to divide into two main categories; one is stenosen type of dyspnea & the other one is tachypnea.
Dyspnea can explain c Howell & Campbell´s "length-tension inappropriateness hypothesis. Whenever, abnormal gas exchange state in arterial blood which induces the hypoxin, hypercapnea or respiratory acidosis etc. Such respiratory distressing conditions induce the pulmonary encephalopathy.
Especially lack of oxygen in arterial blood induces the pulmonary encephalopathy which is called as a CO2 marcosis.
7. Treatment
Described the main principal treatments in various clinical patterns of dyspnea. Emphasized, the basic diagnosis is important always for treatment.
There is no effective treatment without diagnosis. Making the correct diagnosis is an art of medicine.
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