Difficulty exhaling (expiratory dyspnea) is a violation of respiratory function with a significant elongation of exhalation, accompanied by a subjective feeling of bursting, tightness in the chest. The symptom is pathognomonic for bronchial asthma. Expiratory dyspnea is also observed in bronchial obstructive diseases, chronic lung diseases, and some tumors. To identify the causes of difficult exhalation, radiography, spirography, bronchoscopy, laboratory tests are performed. Bronchodilators, glucocorticosteroids, antihistamines, expectorants are used to relieve symptoms.
Causes of difficulty exhaling
Expiratory dyspnea is caused by a violation of the patency of the bronchial tree and is a symptom of an obstructive form of chronic respiratory failure. Bronchial blockage can develop both with organic pathologies of the respiratory tract and with the ingress of a foreign body. Difficult exhalation also occurs in the second stage of asphyxia, when compensatory reactions are depleted and the respiratory center in the medulla oblongata is oppressed. More rare causes of shortness of breath: bronchospasm in Mendelssohn syndrome, tumors of the trachea located near its bifurcation.
The disease is characterized by sudden difficulty in exhaling after contact with provoking substances. A few minutes before the attack, there is a sore throat, nasal congestion, itching of the skin. Then there is a sudden feeling of tightness in the chest, an acute lack of air and the inability to perform normal breathing movements. The inhalation is short, convulsive, the exhalation is significantly prolonged. When exhaling air, whistling sounds and wheezing are heard. To relieve the condition, patients sit down with their legs dangling, lean their hands on their knees or lean on the bed.
During an attack, the patient’s appearance is typical: his eyes are wide open, his face seems puffy, the nasolabial triangle is noticeably blue. When inhaled, the cervical veins swell. Due to the difficulty of exhaling, active chest movements and abdominal tension are noticeable. With mixed bronchial asthma, shortness of breath is provoked not only by contact with allergens, but also by stress, the action of cold air. Attacks of difficult exhalation, occurring exclusively at work, are pathognomonic for professional asthma.
Prolonged paroxysms of difficulty breathing, which are not stopped by the usual drugs, are observed with asthmatic status. A person is constantly in a forced position (orthopnea), there is a sharp cyanosis of the nasolabial triangle, blueness of the fingertips. Patients are restless, gasping for air, some patients are afraid of imminent death. With the progression of respiratory insufficiency, breaths become more and more rare, a person loses consciousness. If emergency medical care is not provided, a fatal outcome is possible.
The disease is accompanied by bronchostenosis, which is why there are constant respiratory disorders of varying severity. In acute obstructive bronchitis, shortness of breath on exhalation occurs more often during a coughing attack. The exhalation phase is significantly prolonged, patients complain of tightness in the chest, suffocation. The pulse quickens, lip cyanosis is possible. Similar attacks of shortness of breath occur throughout the entire period of the disease – about 2-3 weeks. Difficulties of exhalation also indicate a complicated course of chronic bronchitis.
Shortness of breath with minimal physical exertion occurs with bronchitis of smokers, dust bronchitis. At the same time, it is difficult to exhale that becomes one of the first symptoms and appears against the background of normal well-being. For young children, a special form of expiratory suffocation is characteristic due to the narrowing of the smallest bronchi – acute bronchiolitis, complicating acute respiratory viral infections, respiratory syncytial infection. The child has difficulty wheezing, swelling of the wings of the nose, cyanosis of the skin.
Other obstructive diseases
In addition to inflammation of the bronchial tree, other organic pathologies of the respiratory tract can cause difficult exhalation. Violations in these diseases are formed gradually, imperceptibly, so patients do not go to doctors for a long time, which is fraught with a complicated course. The main link of pathogenesis is changes in the structure of the bronchial wall, excessive growth of connective or scar tissue that causes bronchostenosis. Expiratory dyspnea is accompanied by:
- COPD. At the beginning of the disease, there is a slight shortness of breath during physical exertion, which is often overlooked. With the progression of morphological changes in the bronchi, difficulty breathing with prolonged exhalation develops at rest. When an attack occurs, patients occupy a forced position, there is a strong cyanosis of the skin, a paroxysmal painful cough worries.
- Bronchiectatic disease. The appearance of difficulty exhaling indicates the presence of respiratory failure. With bronchiectasis, the symptom may occur regardless of the time of day. Shortness of breath attacks are prolonged, in the terminal stages they are extremely difficult to stop with the help of bronchodilators. In addition to difficulty exhaling, a strong cough develops with the release of copious purulent sputum, pain in the chest area.
- Stenosis of the trachea and bronchi. Expiratory stridor is typical — a noisy labored exhalation, preceded by a short convulsive inhalation. The severity of breathing difficulties depends on the cause of the obstruction, the degree of stenosis. With narrowing of the trachea against the background of shortness of breath, short-term fainting associated with reflex effects on the nerve endings is possible. Bronchostenosis proceeds according to the type of recurrent bronchitis.
- Osteochondroplastic tracheobronchopathy. There are no complaints for a long time. With massive replacement of the walls of the respiratory tract with bone tissue, there is difficulty exhaling, noisy wheezing, patients experience a lack of air. Respiratory disorders are combined with dull pains in the chest cavity, sore throat. Gradually, shortness of breath increases, with a severe form of the disease, attacks of suffocation appear.
- Williams-Campbell syndrome. With this congenital disease, respiratory disorders manifest themselves already in the first months of a child’s life. Parents note that the baby becomes restless, breathing is noisy, stridorous. Severe shortness of breath is indicated by the retraction of intercostal spaces and supraclavicular pits, cyanosis of the nasolabial triangle. The child refuses to breast or nipple, crying becomes quiet.
Chronic lung pathology
Breathing difficulties are caused by both obstructive and restrictive mechanisms. Patients complain of the inability to inhale “full chest”, prolonged exhalation with wheezing wheezes that can be heard at a distance. The symptom sometimes occurs with prolonged pneumonia and other chronic nonspecific lung diseases. Most often shortness of breath causes:
- Emphysema of the lungs. Difficulty exhaling is initially noticed only during physical exertion, climbing several flights of stairs. Patients exhale air through tightly closed or folded lips, while strongly inflating their cheeks, “puffing”. Unlike other diseases, with emphysema, the skin has a healthy, pink color. A similar clinical picture is revealed in the ventilation form of McLeod syndrome.
- Pneumosclerosis. When replacing the pulmonary parenchyma, difficulty breathing occurs both during exercise and at rest. There is an elongation of exhalation, a feeling of lack of air, with prolonged attacks, the fear of death is expressed. Respiratory disorders are accompanied by diffuse cyanosis of the skin. Shortness of breath can occur at any time of the day, but painful suffocation is more often observed at night or in the early morning.
- Ascariasis of the lungs. Difficulty breathing with prolonged exhalation develops against the background of severe chest pain and general intoxication. Typical complaints are frequent and prolonged episodes of shortness of breath, provoked by the allergic effect of helminths. At the time of the attack, a dry cough begins with loud whistling wheezes. The patient sits up on the bed, leans forward and rests his elbows on his knees.
- Deficiency of alpha1-antitrypsin. Symptoms occur in young people with a predominant lesion of the lungs. Difficulties at first bother when doing sports, running, climbing stairs above the 3rd floor. In the future, the elongation of the exhalation is manifested even at rest. During paroxysm, there is a feeling of lack of oxygen, the need to strain the abdominal muscles for a full exhalation. Perioral cyanosis appears, the wings of the nose swell.
Difficulties of exhalation are characteristic of bissinosis, which develops in contact with the dust of spinning raw materials. Respiratory disorders become noticeable after breaks in work – vacations, weekends, which has been called “Monday syndrome”. Expiratory shortness of breath is accompanied by a feeling of heaviness and pressure in the chest, sore throat. The symptom also occurs with massive gasoline pneumonia. In such cases, elongation of exhalation is combined with coughing, wheezing, and general symptoms of intoxication.
Complications of pharmacotherapy
Expiratory dyspnea attacks occur with so-called aspirin asthma. Symptoms appear immediately after taking medications: patients experience painful convulsive breaths and whistling prolonged exhalation. A similar clinical picture is observed in the bronchial type of allergy to salicylates, in this case, difficulties at the time of exhalation persist for 1-3 days after taking medications. The symptom manifests itself with a severe degree of citrate intoxication – long episodes of respiratory disorders are characteristic, in the most difficult cases apnea occurs.
Patients with complaints of difficulty exhaling most often turn to a pulmonologist or therapist. Expiratory dyspnea indicates serious disorders in the respiratory system, therefore it is necessary to conduct a comprehensive laboratory and instrumental examination. During the diagnosis, the specialist evaluates the morphological features of the trachea, bronchi and lungs, and also examines the functional state of these organs. The most informative are:
- X-ray examination. To study the features of the anatomical structures of the thoracic cavity, a standard chest X-ray is performed in two projections — straight and lateral. The method helps to detect bronchial and tracheal deformities, signs of sclerosis and emphysema of the lungs. For better visualization of the respiratory tract and neighboring organs, CT is prescribed.
- Bronchoscopy. Endoscopic examination is aimed at studying the structure of the mucous membrane, identifying pathologically altered tissue areas and scar stenoses. According to the indications, the method is supplemented with forceps biopsy and bronchoalveolar lavage, followed by microscopic and bacteriological analysis of the washing waters.
- Spirometry. It is possible to establish the nature of breathing difficulties by studying the main indicators — the volume of forced exhalation in the first second, the functional vital capacity of the lungs, the Tiffno index. A bronchodilation test is recommended for differential diagnosis between bronchial asthma and other obstructive pulmonary diseases.
- Laboratory tests. The degree of respiratory insufficiency is determined according to blood tests – determine the level of hemoglobin saturation with oxygen, the concentration of carbon dioxide. In the presence of a general infectious syndrome, a bacteriological blood test is indicated. Serological reactions (ELISA, PCR) are carried out to clarify the type of pathogen.
Allergy tests are prescribed to determine the etiological factor of bronchial obstruction in the remission phase. If you suspect a congenital disease of the respiratory system, you need to consult other specialists.
Difficulty in exhaling often indicates organic diseases of the respiratory system, therefore qualified medical care is necessary. If the disorder occurs for the first time and is difficult, you need to urgently call an ambulance. Before the arrival of doctors, it is important for the patient to ensure peace and sufficient fresh air, transfer him to a reclining position, limit contact with possible allergens. To reduce emotional stress, you can offer light sedatives on a plant basis.
If an attack occurs in a patient with an established diagnosis of bronchial asthma, you should immediately take previously prescribed bronchodilators in the form of an aerosol (beta-adrenomimetics, cholinolytics, myotropic antispasmodics). Expectorants can be used for inflammatory diseases, antihistamines can be used for allergic conditions. In other cases, special medications are allowed to be used only after a doctor’s examination, taking into account his recommendations.