RESPIRATORY DISORDERS – Breathe – The Life
Breath is the spirit of one’s life. Breathe is not just meant for act of inhaling and exhaling the air (Respiration), since it itself along with movement of chest (during respiration process) signifies one’s aliveness or presence of soul in the body. Breathe is very important for one’s survival and needs to be carried out round the clock / life (as like heart beat and blood flow). Breathing is a mysterious and marvelous natural function mostly carried out as an involuntary act (automatically) with expertise brain control, i.e. it won’t forget to keep working even during sleep.
One can hold breath for few minutes but one cannot hold life without breathe more than few minutes. Everyone can understand baffling breathe very well on getting clear answers for the following
- Why we breathe?
- What we breathe?
- How we breathe?
- How often we breathe?
- How much air we breathe?
Why we breathe? & what we breathe?
Oxygen is vital for life sustainability and needs to be supplied continuously to carry out cellular metabolism. Deprivation of oxygen can cause cellular death within few minutes. Likewise accumulation of carbon dioxide can also create problems. Among all cells, brain cells are more vulnerable and easily get affected with abnormal levels of oxygen and carbon dioxide. For example, during delivery of a baby – few minutes delay in attaining breath (without cry) can injure brain permanently and can cause death or developmental delays in case of survival.
We breathe especially for the need of oxygen and further to expel the waste and toxic carbon dioxide from the blood. Even though our atmospheric air normally contains Nitrogen 78%, Oxygen 21%, Argon 0.9%, Carbon-dioxide 0.03% and other traces of gases like Neon, Methane, Helium, Krypton, Hydrogen, Xenon, Ozone, Nitrogen Dioxide, Iodine, Carbon Monoxide, Ammonia, etc only oxygen and carbon dioxide are called as respiratory gases and respiration works mainly on them.
How we breathe?
Breathing is a complex process carried out in the chest with the help of nose, pharynx (posterior part of mouth), larynx (throat), trachea (wind pipe), and pulmonary bronchial tree (i.e., bronchus, bronchioles, etc) in synchronize manner. It is otherwise called as Respiration. In this respiration process, air is breathed in and pressurized into the blood. Finally aerated (oxygenated) blood is carried to the heart to supply oxygen to all the parts of the body.
During respiration, nose, pharynx, larynx and trachea function only as pathway and air conditioner. In course of these tracts, air gets filtered, humidified and warmed. Ventilating system (diaphragm, chest muscles, and elastic recoil tendency of lung) inflates and deflates the lung to bring the air in and out.
The core organ of respiration is Lung. It is a spongy rubbery pear shaped organ hanged in the chest. It works as an air filter, air purifier & air charger to the blood. It works like a transport corporation which concerns mainly for loading the oxygen to the blood and unloading the carbon dioxide from the blood. Altogether every one has two lungs – one in right and another in left. Further right lung is subdivided into 3 parts (upper, middle and lower lobe) and left as 2 parts (upper and lower lobe). Each part is supplied with a branch of brochus (branch of trachea) which again and again give out small branches to end as tiny terminal bronchioles. The area of lung supplied by terminal bronchioles is called as Alveoli or Acinus. It is the functional unit of lung where diffusion of gas occurs into the blood of surrounding capillaries (small blood vessels). Haemoglobin (Hb) in the blood is the carrier. It can readily carry oxygen from alveoli as oxy-haemoglobin and can release oxygen to the cells since it is bonded to oxygen very loosely. Alveoli are lined by a special soapy secretion called as surfactant. It helps to lower the surface tension of the lung. The intra alveolar pressure, surfactant and elastic recoil tendency of lung prevents collapsing of lung during respiration and help to do work continuously. All the respiratory process is carried out and controlled by Vagus nerve.
Normally, in an adult male, lung can hold about 2300ml of air (1850ml of air in females). During forcible inspiration, it can further expand to the maximum of 3600ml of air (2600ml of air in females) with chest expansion and can hold the same for sometime. Even though lungs can accommodate more than a litre of air in addition to the normal capacity during forcible inspiration, lungs operate only 500ml of air (400ml of air in females) per breath (by act of inhale and exhale). So, in one minute, lungs need 6-9 litres of air (i.e., under resting condition) for good respiration. During exercises or walking this need may go up to 27 litres / minute and sometimes even more.
Normally exchange of gas (breathing) happens 14-18 times / minute. But it can widely get changed with one’s consciousness i.e. from 12 to 24 per minute. The variation in respiration usually happens during anxiety, tension, nervousness, exercises, high altitudes, hypoxia, humidity, fever, metabolic acidosis, lung infections, heart dysfunctions, etc.
Medical terms commonly used for respiration and its variations are
- Eupnoea – normal respiration
- Apnoea – cessation of respiration
- Dyspnoea – difficulties and irregularities in respiration
(with over consciousness of breathing)
- Hyperpnoea – Increase in respiratory depth (volume of air)
- Tachypnoea – Increase in rate of respiration
Good breathe often provides good amount of oxygen and thus good health. So, generally to improve one’s health / stamina / wellness of life, one needs to improve lung efficiency with good exercises / sportive activities and deep breathing exercises.
Breathlessness – Want of breathe
Worthiness of anything can be realized only when it goes out of order. Lung is no way exception, i.e., even though every one breathes round the clock, no one knows the worth / work of untiring lungs. But, when a problem arises in the lung to manifest symptoms (gasping for breath or taking deep breathe often, etc.), with the fear of life, every one’s consciousness will be with lungs only. Ancestors may say soul remains in chest, heart, brain, air, blood, etc., but for patients suffering with breathlessness, it remains in lungs. For them, quality of life depends on the functional ability of lung / respiration only.
Breathlessness is commonly meant for shortness in breathing or difficulty in breathing (inspiration or expiration). Medically it is termed as Dyspnoea. Every one might have felt the breathlessness by one or other time, i.e. after violent exercise, running for a prolonged period, climbing staircase, when getting overweight, etc. It occurs commonly for the need of more oxygen supply or as an indicative of imbalance in respiratory gases (oxygen and carbon-dioxide) or due to other illnesses.
incidences – Breathlessness can occur in any one in any of the time with triggers. Generally elderly people suffer with breathlessness with strain and degenerative (lung or other) disorders. Now-a-days due to pollutants, low immune power and recurrent uncontrolled infections, children also happen to suffer more with respiratory complaints and breathlessness. The incidences of having breathlessness are more with sedentary people and less with sportive and hard workers. Hefty / obese people also often suffer with breathlessness while climbing stairs or while attempting any strain.
pathology – Even though lung remains as an inner part of the body, it is exposed to the chemicals and pollutants as equal to the outer surface of the body, since one cannot avoid breathing atmospheric air. Pollution and improper attention to the disease in initial period can drag one to degenerative changes / structural damages of the lung and breathlessness.
Commonly breathlessness occurs due to lack of oxygen supply, airway obstruction / narrowing and airway inflammations. In case of inhaling irritants, respiratory centre in medulla (in brain) triggers lungs to cough out the irritant air and initiates respiration in faster manner to exhale every part of irritant air and inhale fresh air. The chemical receptor in the respiratory centre keeps on analysis of the carbon-dioxide load in the blood. If carbon-dioxide exceeds to alarming level, with increased metabolism of the body, it provokes the lung to breathe more and more fresh air. In extreme condition it may be felt as breathlessness.
Causes of Breathlessness – Breathlessness can be caused by variety of problems and breathlessness can also cause variety of problems. No one can predict the exact cause (unless otherwise it is physiological – running / climbing stairs, etc.) and label the disease without a detailed analysis. Even though nose, throat, trachea and lungs are involved in breathing process, breathlessness need not to be confined with them. It can also be due to various other diseases or disorders too – for example heart diseases, anaemia, liver failure, kidney failure, etc. Causes are commonly classified in the following way
- External factors
- Internal factors
- Psychological factors
External factors –
- Low or inadequate supply of oxygen – for example in high altitudes, poor ventilated rooms, in congested crowds, etc.
- Extreme of temperature
- Violent exercises (especially in cold temperature)
- Infections – bacterial / viral / fungal – causing cold and cough
- Bites of Insects / mites
- Allergic tendency or hypersensitivity or immune response of body to cause oedema of lungs.
- Drugs (due to sensitivity or allergy)
- Pollutants – dust, smoke (industrial or cigarette or of automobiles), pollens, furs of animals / birds, preservatives in foods, chemical irritants / acids,
- Aspiration of small foreign bodies (parts of toys, foods during deglutition, pins, etc) entering into upper or lower respiratory tract causing obstruction or cramps or irritations
Internal factors –
- Nose – allergic rhinitis, sinusitis, post nasal drip, nose block (nasal polyps), etc
- Throat – Laryngitis, Pharyngitis, Complaints of Vocal cord, Thyroid complaints, etc.
- Lung – Acute bronchitis, Chronic bronchitis, Emphysema (COPD – chronic obstructive pulmonary diseases), Asthma, Tuberculosis, Pneumonia, Bronchiectasis, Lung cancer, Pneumothorax, Pleurisy, Pulmonary oedema / hypertension, Pulmonary embolism, Cystic fibrosis, etc.
- Excessive secretions or mucous in nose, throat, sinuses and lungs
- Heart – Congestive cardiac failure (heart failure), Myocardial infarction (heart attack), Arrhythmias, valvular dysfunctions (stenosis or prolapse), etc
- Stomach – Reflux oesophagitis, hiatus hernia, etc.
- Blood – Anaemia
- Poor functions of other parts of body – for example liver failure, kidney failure, etc. with water retention and puffiness of the body
- Loss of body fluids / vitamins and minerals and weakness of body
Psychological factors – Stress, tension, fear, anger, anxiety and excessive laugh can cause or intensify the breathlessness. Moral support can bring the sufferer to peace and unruffled state. Some may also breathe unusually and may acts as if they are suffering with breathlessness to draw attention towards them.
Types of Breathlessness – Breathlessness may be for inhalation or exhalation. Pattern of breathlessness may also vary depending upon its causes and management. Normally, duration of inspiration will be twice that of expiration time. In case of obstruction it will be reversed.
Auscultation of breathing sounds (with stethoscope) can point out infection or obstruction site and provide clue to diagnosis. The common abnormal sounds are crepitations, rales, rhonchi, wheeze and stridor. The breathing sounds will get muffled or absent in case of reduced air flow to the parts of lungs, over inflation of lungs (emphysema) and due to fluid or air collection around lungs (pleurisy or pneumo thorax). Normally, bronchial breathing is heard over bronchus or trachea, broncho-vesicular breathing is heard over hilar area, and vesicular breathing is heard all over the chest and classically over axillary and scapular areas. The common abnormal breathing are
- Gasping for air often (with deep breathe) – occurring commonly with weakness, low BP, lowered sugar level, etc.
- Rapid breathing / Hyperpnoea / Shortness in breath / Shallow breathing – exercise, fever, cold, weakness, stress, etc.
- Wheeze (breath with whistling sound) – Asthma, cardiac asthma, etc.
- Stridor (short crowing sound occurring mostly during inspiration) – laryngeal tumours, vocal cord dysfunctions, oedema of epliglottis, etc
- Exertional dyspnoea (difficulty in breathing with movements or work or exercise) – weakness, low BP, lowered sugar level, etc.
- Nocturnal dyspnoea (difficulty in breathing in night) – heart failure
- Orthopnoea (mostly on lying / nocturnal) – heart failure, hiatus hernia
- Sleep Apnoea (getting up from sleep due to lack of breathe) – upper respiratory infection, heart failure, nasal polyp, etc.
- Snoring (difficulty in breathing with obstruction in nasal pathway) – nasal polyp
- Cheyne stokes breathing (abnormal pattern of breathing which often vary from Apnoea to Hyperpnoea) – common in brain damages, strokes and heart failures
Breathlessness affects oxygen supply to the body which is very essential for survival of the parts / life. So, it can cause impact in any system of our body to cause various complaints / symptoms.
Generally manifest with exciting causes (allergens, dust exposure, strain, change of temperature, infection, etc) or seasonally for transient period or in persistent manner depending upon the disease, its intensity and sensitivity of the sufferer. Period of suffering and frequency of suffering also usually differs with disease and management. The common symptoms of breathlessness are
- Smothering feeling with want of more air or fanning
- In severe cases sufferer often feels like choked
- Restlessness and constantly changing / adjusting positions to get ease and comfort breathe
- Cough / croup sounds during breathe Inability to speak or work
- In due course have shortness in breath / fast and irregular breathing
- Heaviness in chest
- Nasal flaring
- Stooping of shoulders to ease the breathe
- Cyanosis – bluish tinge around mouth, tongue and in nails
- Clubbing of finger nails (in case of untreated / neglected cases)
complications – Breathlessness is often misdiagnosed. Also most of the persons neglect breathlessness in initial period and go for treatment while it curtails their movements (with development of complications – cyanosis, clubbing of finger, weakening of immune system, deformities of chest (Barrel chest / peacock chest) etc. Since breathlessness can occur as a serious sign of heart attack and other life threatening illnesses, it needs to be cared and treated at the earliest to avoid advancement of disease & life threatening emergencies. To curb the disease at the earliest, it must always be properly diagnosed with detailed investigations, otherwise complications are inevitable.
Prevention and Management – Prevention is always better than cure. This implies to breathlessness also. Controlling and preventing infection of lung can aid to get rid off the disease / suffering at the earliest. One can become comfortable easily by staying calm without any tension in open air and by improving quality of living with good air, water, food, and surroundings. To stay away from attacks of breathlessness, one need to
- Congested and poorly ventilated areas
- Strenuous and violent exercises
- Exposure to extreme of temperatures
- Avoid direct blow of air from air conditioners
- Infections following hygienic measures
- Allergens / dust / smoke / chemical contacts / perfumes (work out a list of triggers and try to avoid them permanently if possible)
- Smoking and stimulants
- Preservative added foods / tin packed foods
- Unnecessary drugs
- Take adequate rest
- Use masks when entering smoky or dusty area
- Go for brisk walking and sportive activities to enhance lung functions.
- Do breathing exercises
- Control infections caring complaints then and there
Diagnosis – Breathlessness can indicate a crucial time / emergency condition to save one’s life. So it need to be properly diagnosed to proceed to proper treatment at the earliest. Following proceedings can help to fix the disease.
- Listen for any audible wheeze or crepitations (in severe asthma / obstruction / stridor)
- Check for any abnormality in Respiratory rate, Pulse, Heart rate, Blood pressure and temperature.
- Check for any blueness (cyanosis) in tongue / around mouth or in any part.
- Palpation and percussion of the chest with hand for resonance
- Auscultation of chest with stethoscope for breath nature – check for any added sounds / crepitations / wheeze
- Locate the site of wheeze or abnormal breathing sound (if there is any).
- Look for the character of breathing sound (if there is any)
- Do blood tests to rule out allergy, anaemia and involvement of liver, heart, kidney and thyroid (i.e. TC, DC, ESR, HB%, RBC’s, Sugar, Albumin, Cholesterol, urea, creatinine, liver function tests, thyroid function tests, etc)
- Go for radiological evaluation of Chest and Sinuses
- Analyse sputum with colour and volume (rusty sputum – pneumonia / slimy sputum – cold / frothy sputum – wheeze / highly coloured foul smelling sputum – lung abscess / bloody sputum – heart failure, pulmunory hypertension, tuberculosis)
- Do throat swab and Sputum culture in case of infection
- Do lung function test with peak flow meter to analyse the lung capacity and function.
- Do measurement of Blood gases to analyse the cause
- Do stool for ova / cyst
- Do skin allergy test to rule out hypersensitivity
The method of treatment and medications usually varies depending upon the cause of the disease and intensity of the sufferings. With any system of medicines, early treatment is the best. If treatment is opted very late (i.e., in advanced condition), then medicine world can provide only temporary relief, that too to a certain extent only. I.e. till the complaint remains as a functional complaint, condition can be revoked completely – 100% normalcy as before with medicines, but after getting structural damages, one may need life long maintenance therapy to lead an adjustment life with disease.
Homeopathy can ease breathlessness amazingly with out any side effects by clearing all possible causes, i.e. Homeopathy medicines can increase air flow to lungs, treat and prevent diseases by improving stamina & resistance power, etc. It can help for good lung functions also. In the safe hands of homeopathy, one can easily & absolutely get rid off the disease and can outweigh all the risks.
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011 (Mob)
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)