Der Pneumologe

, Volume 9, Issue 4, pp 254–261 | Cite as

Pulmonale Dyspnoe

Leitthema
  • 311 Downloads

Zusammenfassung

Dyspnoe ist ein wesentliches Symptom bei chronischen Erkrankungen der Atmung, das zu verminderter Aktivität, Dekonditionierung und Einschränkung der Lebensqualität führt. Es entsteht durch eine Störung im Bereich des Gasaustauschs, der Atemmuskelpumpe oder der zentralen Atemregulation. Dabei lässt sich zwischen hypoxischem Lungenversagen mit Störungen des Gasaustauschs z. B. bei Lungenfibrose und hyperkapnischem Pumpversagen mit Störungen der alveolären Ventilation z. B. bei Kyphoskoliose oder obstruktiven Lungenerkrankungen unterscheiden. Beim initialen Patientenkontakt ist es wichtig, sofort den Schweregrad der Symptomatik zu erfassen und symptomatische Therapiemaßnahmen einzuleiten. Anamnese und körperliche Untersuchung sind die Hauptpfeiler der Diagnostik zur weiteren Eingrenzung der in Frage kommenden Erkrankungen und werden durch gezielte weitere Untersuchungen ergänzt. Bei Lungenerkrankungen wie COPD, Lungenfibrose oder Lungenhochdruck kommt es zu einer langsam zunehmenden Dyspnoe, daher wird die Diagnose oft erst spät im Krankheitsverlauf gestellt. Bei Patienten mit fortgeschrittenen Malignomen ist Dyspnoe ein häufiges und sehr belastendes Symptom, das von den Behandelnden jedoch weniger beachtet wird als das Symptom Schmerz. Ziel der Therapie bei chronischen Lungenerkrankungen ist eine Linderung der Dyspnoe. Abhängig von der zugrunde liegenden Erkrankung kann eine Kombination aus medikamentöser Therapie, symptomatischen Maßnahmen, nichtinvasiver Beatmung und Training zum Erhalt der Muskulatur eingesetzt werden.

Schlüsselwörter

Respiratorische Erkrankung Chronische Erkrankung Lungenerkrankung Pulmonale Hypertonie Diagnosetechniken und -prozeduren 

Pulmonary dyspnea

Abstract

Dyspnea is a major symptom of patients with chronic respiratory diseases leading to activity limitation, deconditioning and a decreased quality of life. It results from impairments in gas exchange, balance between the load on and capacity of the respiratory muscles and increased neural respiratory drive. It can be distinguished from hypoxic failure due to disturbances in gas exchange, e.g. in pulmonary fibrosis and hypercapnic failure of the ventilatory pump, e.g. in chronic obstructive pulmonary disease (COPD) or kyphoscoliosis. Medical history and physical examination are the mainstays of diagnostic evaluation. In addition specific laboratory, radiographic and clinical examinations are performed depending on the symptoms and the diagnostic possibilities. In patients with chronic lung diseases, e.g. COPD, pulmonary fibrosis or pulmonary hypertension, dyspnea often progresses relentlessly with time to reach incapacitating levels. Therefore, the diagnosis is frequently made late in the course of the disease. In patients with malignancies dyspnea is a frequent symptom, which, however, is less recognized than pain. Treatment goal of dyspnea in chronic lung diseases is relief of dyspnea. Depending on the underlying disease a combination of medical therapy, symptomatic treatment, noninvasive ventilation and physical training can be applied.

Keywords

Respiration disorder Chronic disease Lung disease Pulmonary hypertension Diagnostic techniques and procedures 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Aliverti A, Stevenson N, Dellacà RL et al (2004) Regional chest wall volumes during exercise in chronic obstructive pulmonary disease. Thorax 59:210–216PubMedCrossRefGoogle Scholar
  2. 2.
    Banzett RB, Pedersen SH, Schwartzstein RM et al (2008) The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort. Am J Respir Crit Care Med 177:1384–1390PubMedCrossRefGoogle Scholar
  3. 3.
    Behr J (2012) Idiopathic pulmonary fibrosis – modern guideline-concordant diagnostics and innovative treatment. Dtsch Med Wochenschr 137(12):601–604PubMedCrossRefGoogle Scholar
  4. 4.
    Blasi F (2012) The challenge of breathlessness in the detection of pulmonary hypertension. Eur Respir Rev 21(123):1–3PubMedCrossRefGoogle Scholar
  5. 5.
    Brack T, Jubran A, Tobin MJ (2002) Dyspnea and decreased variability of breathing in patients with restrictive lung disease. Am J Respir Crit Care Med 165:1260PubMedCrossRefGoogle Scholar
  6. 6.
    Celli BR, Cote CG, Marin JM et al (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350:1005–1012PubMedCrossRefGoogle Scholar
  7. 7.
    De DePaso WJ, Winterbauer RH, Lusk JA et al (1991) Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Analysis of a seven-year experience. Chest 100:1293–1299CrossRefGoogle Scholar
  8. 8.
    Evans KC (2010) Cortico-limbic circuitry and the airways: insights from functional neuroimaging of respiratory afferents and efferents. Biol Psychol 84:13–25PubMedCrossRefGoogle Scholar
  9. 9.
    Feinstein MB, Krebs P, Coups EJ et al (2010) Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. J Thorac Oncol 5(8):1221–1226PubMedCrossRefGoogle Scholar
  10. 10.
    Galiè N, Hoeper MM, Humbert M et al (2009) Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC); European Respiratory Society (ERS); International Society of Heart and Lung Transplantation (ISHLT). Eur Respir J 34(6):1219–1263PubMedCrossRefGoogle Scholar
  11. 11.
    Goldberg P, Roussos C (1990) Assessment of respiratory muscle dysfunction in chronic obstructive lung disease. Med Clin North Am 74(3):1006–1033Google Scholar
  12. 12.
    Jones PW, Wijkstra PJ (2006) Quality of life in patients with chronic obstructive pulmonary disease. Eur Respir Mon 38:375–386CrossRefGoogle Scholar
  13. 13.
    Laveneziana P, Lotti P, Coli C et al (2006) Mechanisms of dyspnoea and its language in patients with asthma. Eur Respir J 27:742–747PubMedCrossRefGoogle Scholar
  14. 14.
    Leblanc P, Bowie DM, Summers E et al (1986) Breathlessness and exercise in patients with cardiorespiratory disease. Am Rev Respir Dis 133:21–25PubMedGoogle Scholar
  15. 15.
    Macklem PT (1980) Respiratory muscles: the vital pump. Chest 78(5):753–758PubMedCrossRefGoogle Scholar
  16. 16.
    Mahler DA, Selecky PA, Harrod CG et al (2010) American college of chest physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest 137(3):674–691PubMedCrossRefGoogle Scholar
  17. 17.
    Martinez FJ, Stanopoulos I, Acero R et al (1994) Graded comprehensive cardiopulmonary exercise testing in the evaluation of dyspnea unexplained by routine evaluation. Chest 105(1):168–174PubMedCrossRefGoogle Scholar
  18. 18.
    McCannon J, Temel J (2012) Comprehensive management of respiratory symptoms in patients with advanced lung cancer. J Support Oncol 10(1):1–9PubMedCrossRefGoogle Scholar
  19. 19.
    Moxham J, Jolley C (2009) Breathlessness, fatigue and the respiratory muscles. Clin Med 9(5):448–452Google Scholar
  20. 20.
    Mularski RA, Campbell ML, Asch SM et al (2010) A review of quality of care evaluation for the palliation of dyspnea. Am J Respir Crit Care Med 181(6):534–538PubMedCrossRefGoogle Scholar
  21. 21.
    O’Donnell DE, Chau LK, Webb KA (1998a) Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. J Appl Physiol 84:2000–2009Google Scholar
  22. 22.
    O’Donnell DE, Ora J, Webb KA et al (2009) Mechanisms of activity-related dyspnea in pulmonary diseases. Respiratory Physiology & Neurobiology 167(1):116–132Google Scholar
  23. 23.
    Parshall MB, Schwartzstein RM, Adams L et al (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185(4):435–452PubMedCrossRefGoogle Scholar
  24. 24.
    Pratter MR, Curley FJ, Dubois J et al (1989) Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 149:2277PubMedCrossRefGoogle Scholar
  25. 25.
    Rich S, Dantzker DR, Ayres SM et al (1987) Primary pulmonary hypertension. A national prospective study. Ann Intern Med 107(2):216–223PubMedGoogle Scholar
  26. 26.
    Scano G, Stendardi L, Grazzini M (2005) Understanding dyspnoea by its language. Eur Respir J25:380CrossRefGoogle Scholar
  27. 27.
    Schön D, Rosenkranz M, Regelsberger J et al (2008) Reduced perception of dyspnea and pain after right insular cortex lesions. Am J Respir Crit Care Med 178:1173–1179PubMedCrossRefGoogle Scholar
  28. 28.
    Simon PM, Schwartzstein RM, Weiss JW et al (1990) Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis 142:1009–1014PubMedGoogle Scholar
  29. 29.
    Simon ST, Higginson IJ, Booth S et al (2010) Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 20(1):CD007354Google Scholar
  30. 30.
    Viola R, Kiteley C, Lloyd NS et al (2010) Supportive Care Guidelines Group of the Cancer Care Ontario Program in evidence-based care. The management of dyspnea in cancer patients: a systematic review. Cochrane Database Syst Rev 20(1):CD007354Google Scholar
  31. 31.
    Gent R van, Essen-Zandvliet LE van, Rovers MM et al (2007) Poor perception of dyspnoea in children with undiagnosed asthma. Eur Respir J 30(5):887–891PubMedCrossRefGoogle Scholar
  32. 32.
    Leupoldt A von, Sommer T, Kegat S et al (2009) Dyspnea and pain share emotion-related brain network. Neuroimage 48:200–206CrossRefGoogle Scholar
  33. 33.
    Wilkens H, Weingard B, Lo Mauro A et al (2010) Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after lung transplantation. Thorax 65:808–814PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Medizinische Klinik VUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland

Personalised recommendations