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Dyspnoe

Dyspnea

  • Leitthema
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Zusammenfassung

Dyspnoe ist eines der häufigsten Leitsymptome, das zu einem Arztbesuch führt. Die Ursachen der Dyspnoe sind vielfältig und betreffen nicht nur Erkrankungen des kardiorespiratorischen Systems, sondern auch metabolische, neuromuskuläre und andere Störungen. Für die Diagnostik und die notwendigen Therapiemaßnahmen ist es zunächst von großer Bedeutung, zwischen akuter und chronischer Atemnot zu unterscheiden. Der Beitrag befasst sich neben den Differenzialdiagnosen, der Diagnostik und der Therapie der Dyspnoe auch mit der Pathophysiologie und der Problematik der Objektivierbarkeit dieses Symptoms.

Abstract

Dyspnea is one of the most frequent leading symptoms that prompts patients to seek medical advice. The causes of dyspnea are multifaceted and affect not only diseases of the cardiorespiratory system but also metabolic, neuromuscular, and other disorders. It is first essential to differentiate between acute and chronic respiratory depression for the diagnostic work-up to initiate the necessary therapeutic measures. This article addresses the differential diagnoses, diagnostics, and treatment of dyspnea as well as the pathophysiology and problems involved in the ability to objectify this symptom.

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Literatur

  1. Ando T, Ogawa K, Yamaki K et al. (1996) Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseases. Chest 110:462–468

    Google Scholar 

  2. ATS (1999) Dyspnea. Mechanisms, assessment, and management: a consensus statement. Am J Respir Crit Care Med 159:321–340

    Google Scholar 

  3. Banzett RB, Lansing RW, Brown R et al. (1990) „Air hunger“ from increased PCO2 persists after complete neuromuscular block in humans. Respir Physiol 81:1–17

    Google Scholar 

  4. Banzett RB, Mulnier HE, Murphy K et al. (2000) Breathlessness in humans activates insular cortex. Neuroreport 11:2117–2120

    Google Scholar 

  5. Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2:92–98

    Google Scholar 

  6. Bradley BL, Garner AE, Billiu D et al. (1978) Oxygen-assisted exercise in chronic obstructive lung disease. The effect on exercise capacity and arterial blood gas tensions. Am Rev Respir Dis 118:239–243

    Google Scholar 

  7. Bruera E, de Stoutz N, Velasco-Leiva A et al. (1993) Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet 342:13–14

    Google Scholar 

  8. Bye PT, Esau SA, Levy RD et al. (1985) Ventilatory muscle function during exercise in air and oxygen in patients with chronic air-flow limitation. Am Rev Respir Dis 132:236–240

    Google Scholar 

  9. Cabanes L, Richaud-Thiriez B, Fulla Y et al. (2001) Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea. Chest 120:2047–2050

    Google Scholar 

  10. Chonan T, Mulholland MB, Cherniack NS, Altose MD (1987) Effects of voluntary constraining of thoracic displacement during hypercapnia. J Appl Physiol 63:1822–1828

    Google Scholar 

  11. Chonan T, Mulholland MB, Leitner J et al. (1990) Sensation of dyspnea during hypercapnia, exercise, and voluntary hyperventilation. J Appl Physiol 68:2100–2106

    Google Scholar 

  12. Dao Q, Krishnaswamy P, Kazanegra R et al. (2001) Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 37:379–385

    Google Scholar 

  13. Dudgeon DJ, Lertzman M (1998) Dyspnea in the advanced cancer patient. J Pain Symptom Manage 16:212–219

    Google Scholar 

  14. Elliott MW, Adams L, Cockcroft A et al. (1991) The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease. Am Rev Respir Dis 144:826–832

    Google Scholar 

  15. Eyzaguirre C, Zapata P (1984) Perspectives in carotid body research. J Appl Physiol 57:931–957

    Google Scholar 

  16. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH (1959) The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J 5147:257–266

    Google Scholar 

  17. Grazzini M, Ottanelli R, Duranti R et al. (2002) Measures of perception of bronchoconstriction and clinical and functional data are not interrelated in asthma. Respiration 69:496–501

    Google Scholar 

  18. Harris-Eze AO, Sridhar G, Clemens RE et al. (1994) Oxygen improves maximal exercise performance in interstitial lung disease. Am J Respir Crit Care Med 150:1616–1622

    Google Scholar 

  19. Johnson MA, Woodcock AA, Geddes DM (1983) Dihydrocodeine for breathlessness in „pink puffers“. Br Med J (Clin Res Ed) 286:675–677

    Google Scholar 

  20. Leblanc P, Bowie DM, Summers E et al. (1986) Breathlessness and exercise in patients with cardiorespiratory disease. Am Rev Respir Dis 133:21–25

    Google Scholar 

  21. Leung R, Hill P, Burdon J (1996) Effect of inhaled morphine on the development of breathlessness during exercise in patients with chronic lung disease. Thorax 51:596–600

    Google Scholar 

  22. Mahler DA, Rosiello RA, Harver A et al. (1987) Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease. Am Rev Respir Dis 135:1229–1233

    Google Scholar 

  23. Mahler DA, Harver A, Lentine T et al. (1996) Descriptors of breathlessness in cardiorespiratory diseases. Am J Respir Crit Care Med 154:1357–1363

    Google Scholar 

  24. Maisel A (2001) B-type natriuretic peptide in the diagnosis and management of congestive heart failure. Cardiol Clin 19:557–571

    Google Scholar 

  25. Maisel AS, Krishnaswamy P, Nowak RM et al. (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167

    Google Scholar 

  26. Manning H (1998) Invited editorial on „Effects of chest wall vibration on breathlessness during hypercapnic ventilatory response“. J Appl Physiol 84:1485–1486

    Google Scholar 

  27. Manning HL, Molinary EJ, Leiter JC (1995) Effect of inspiratory flow rate on respiratory sensation and pattern of breathing. Am J Respir Crit Care Med 151:751–757

    Google Scholar 

  28. Manning HL, Shea SA, Schwartzstein RM et al. (1992) Reduced tidal volume increases ‚air hunger‘ at fixed PCO2 in ventilated quadriplegics. Respir Physiol 90:19–30

    Google Scholar 

  29. McCullough PA, Nowak RM, McCord J et al. (2002) B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 106:416–422

    Google Scholar 

  30. McGavin CR, Artvinli M, Naoe H, McHardy GJ (1978) Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Br Med J 2:241–243

    Google Scholar 

  31. Morrison LK, Harrison A, Krishnaswamy P et al. (2002) Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 39:202–209

    Google Scholar 

  32. Moy ML, Woodrow Weiss J, Sparrow D et al. (2000) Quality of dyspnea in bronchoconstriction differs from external resistive loads. Am J Respir Crit Care Med 162:451–455

    Google Scholar 

  33. Nolte D (1985) Asthma, Atemnot, Atemfunktion. Gedon & Reuss, München, S 87

  34. O’Donnell DE, Webb KA (1993) Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation. Am Rev Respir Dis 148:1351–1357

    Google Scholar 

  35. O’Donnell DE, Bertley JC, Chau LK, Webb KA (1997) Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med 155:109–115

    Google Scholar 

  36. Peiffer C, Poline JB, Thivard L et al. (2001) Neural substrates for the perception of acutely induced dyspnea. Am J Respir Crit Care Med 163:951–957

    Google Scholar 

  37. Pratter MR, Curley FJ, Dubois J, Irwin RS (1989) Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 149:2277–2282

    Google Scholar 

  38. Rice KL, Kronenberg RS, Hedemark LL, Niewoehner DE (1987) Effects of chronic administration of codeine and promethazine on breathlessness and exercise tolerance in patients with chronic airflow obstruction. Br J Dis Chest 81:287–292

    Google Scholar 

  39. Rochester DF (1993) Respiratory muscles and ventilatory failure: 1993 perspective. Am J Med Sci 305:394–402

    Google Scholar 

  40. Rubinfeld AR, Pain MC (1976) Perception of asthma. Lancet 1:882–884

    Google Scholar 

  41. Schwartzstein RM, Simon PM, Weiss JW et al. (1989) Breathlessness induced by dissociation between ventilation and chemical drive. Am Rev Respir Dis 139:1231–1237

    Google Scholar 

  42. Seamens CM, Wrenn K (1995) Breathlessness. Strategies aimed at identifying and treating the cause of dyspnea. Postgrad Med 98:215–216, 219–222, 225–217

    Google Scholar 

  43. Simon PM, Schwartzstein RM, Weiss JW et al. (1990) Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis 142:1009–1014

    Google Scholar 

  44. Stein DA, Bradley BL, Miller WC (1982) Mechanisms of oxygen effects on exercise in patients with chronic obstructive pulmonary disease. Chest 81:6–10

    Google Scholar 

  45. Swinburn CR, Wakefield JM, Jones PW (1984) Relationship between ventilation and breathlessness during exercise in chronic obstructive airways disease is not altered by prevention of hypoxaemia. Clin Sci (Lond) 67:515–519

    Google Scholar 

  46. Taguchi O, Kikuchi Y, Hida W et al. (1991) Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea. J Appl Physiol 71:2183–2190

    Google Scholar 

  47. Wasserman K, Casaburi R (1988) Dyspnea: physiological and pathophysiological mechanisms. Annu Rev Med 39:503–515

    Google Scholar 

  48. Wilson RC, Jones PW (1991) Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise. Clin Sci (Lond) 80:65–70

    Google Scholar 

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Pfeifer, M. Dyspnoe. Pneumologe 2, 177–187 (2005). https://doi.org/10.1007/s10405-005-0044-1

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  • DOI: https://doi.org/10.1007/s10405-005-0044-1

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