Sudden Breathlessness Crisis - Everything You Need to Know

Introduction:

Breathlessness is a distressing symptom of several long-term respiratory, cardiopulmonary, and cancerous conditions that are prevalent globally. It affects the patient’s quality of life and has a widespread impact on their personal and social lives. Unfortunately, despite proper intervention and management of the underlying diseases, the difficulty in breathing often persists and eventually leads to disability. This article will review the sudden breathlessness crisis, its features, causes, and management.

What Is a Sudden Breathlessness Crisis?

A sudden episode of breathlessness can create a plight. It can be concerning and difficult for the patient, family members, and the patient’s health care provider. A sudden and severe attack of breathlessness that comes quickly and does not go away immediately is referred to as a sudden breathlessness crisis.

The word healthcare workers use to describe shortness of breath, or breathlessness is dyspnea. Not every individual with a chronic lung or cardiopulmonary disease experiences a sudden breathlessness crisis. It is often seen in patients with advanced respiratory, cardiac, or nervous diseases and dying patients.

What Is Dyspnea?

Dyspnea is a subjective sensation of difficult or uncomfortable breathing. Patients commonly describe it as shortness of breath or air hunger. It is a common symptom affecting millions of people with underlying respiratory, cardiac, nervous, systemic, and psychological illnesses. Dyspnea can be acute, lasting for hours to days, and chronic, lasting more than four to eight weeks.

1. Respiratory Causes Include:

• Asthma (inflammation of airways and excess mucous production).
• Exacerbations of chronic obstructive pulmonary disorder (COPD - airway constriction resulting in difficult breathing).
• Pneumonia (fluid-filled lungs).
• Lung malignancy (cancer).
• Pneumothorax (presence of air between the lung and chest wall).
• Pulmonary embolism (blood clots in the arteries of the lungs).
• Aspiration (accidental withdrawal of food or liquid into the lungs).

2. Cardiovascular Causes Include:

• Congestive heart failure (when the heart muscles do not pump enough blood).
• Pulmonary hypertension (increased blood pressure of the pulmonary vasculature).
• Valvular heart defects (defects in the heart valves).
• Cardiac arrhythmias (irregular heartbeat).

3. Neuromuscular Causes Include:

• Phrenic nerve paralysis (contraction of the diaphragm is not possible).
• Flail chest ( fracture of the ribs at two or more places makes the chest wall unstable).
• Myopathy (weakness of muscles).
• Neuropathy (weakness of the nerves).
• Dysfunction of the central nervous system or the spinal cord.

How Can Someone Know if They Have a Sudden Breathlessness Crisis?

For patients with breathing problems, in certain situations, their breathing will be more adverse than usual. The patient might feel breathlessness even when their oxygen levels are normal. It does not necessarily indicate an episode of breathlessness crisis. For example, breathlessness experienced might be similar to an event in the past, resolved by itself or with usual treatment. However, in the case of a sudden breathlessness crisis, the patient experiences a sudden shortage of air or difficulty breathing that is severe. It does not usually go away by itself. The patient usually describes it as the worst shortage of breathing that they have ever experienced and ends up in a panic situation for themselves and the people around them. The situation is often referred to as a flight or fight reaction.

The series of events occur cyclically. A sudden worsening of breathing leads to fear, anxiety, and avoidance of activities, leading to panic and uncertainty. The panic will trigger further breathlessness repeating the series of events.

What Are the Factors That Worsen the Sudden Breathlessness Crisis?

The following situations may worsen the breathlessness.

• A spreading infection or pneumonia.

• An exacerbation of a chronic pulmonary or cardiac disease.

• Environmental triggers include exposure to certain chemicals or wood smoke, air pollution, perfume or fragrances, and weather changes like high humidity, cold/hot weather, and wind.

• Moving to higher altitudes.

• Panic, fear, and anxiety.

The connection between the mind and body is very powerful. In a strenuous situation of sudden breathlessness, emotions like losing control, fear of death, and outrage can trigger a breathlessness crisis.

How to Manage the Sudden Crisis of Breathlessness?

Emergency medical intervention is required to manage a case of a breathlessness crisis. The patient admitted to the emergency room should be administered supplemental oxygen and constantly monitored through pulse oximetry (a test to measure blood oxygen saturation) and a cardiac monitor. Once the patient is stabilized, appropriate therapy must be initiated for the underlying disease.

However, a previously worked out and practiced ritual can help control the symptoms, decrease the sense of panic, fear, and anxiety, and give the patient a feeling of control. Therefore, a step-by-step plan is devised to anticipate a sudden episode of severe breathlessness so the patient, family, and caregivers can cope with the depressing situation.

The step-by-step strategy involves the one that works best for a patient and the order in which it is practiced. Though, not all steps work for every individual.

• Always begin with the methods that have worked before in the event of breathlessness, like inhalers or oral medications, pursed lip breathing (breathing in through the nose and breathing out through the mouth), and directing a fan to the cheeks, six to eight inches away.

• Secondly, make changes in position that will help ease breathing. For example, if the patient is sitting, they should lean forward and rest their elbow on a table or place their hands or elbows on the knees in a tripod position. If the patient stands, use a counter to do the tripod position.

A 'COMFORT' plan suggested by the American thoracic society for managing sudden breathlessness crises is:

1. C: Call For Help: Set up emergency contacts on mobile phones to let the family or caregivers know when the patient needs help.

2. O: Observe: Signs of distressful breathing like fast breathing, tightening of neck muscles, forceful stomach movement with breathing, and feeling of chest pounding.

3. M: Medications: Always keep the medications for breathlessness, like inhalers, nebulizers, and medications for anxiety, ready to use.

4. F: Fan to the Face: Open windows or direct the fan to the face to increase air circulation across the face.

5. O: Oxygen: Use oxygen supplements prescribed by the health care provider.

6. Reassure and Relax: Do activities that calm the surrounding.

7. Take Your Time.

Conclusion:

A sudden breathlessness crisis is a serious situation and, if not managed properly, may result in unfortunate outcomes. Appropriate medical intervention and practice of a step-by-step management strategy by the patient, their family, and the caretakers will help manage the condition more efficiently and successfully.