Диспноэ

Description:

Диспноэ (synonyms: an asthma, respiratory discomfort) is one of the most frequent reasons of the request of the patient for medical care. According to the Fremingemsky research, prevalence диспноэ in the general population of the population depending on gender and age (persons of 37-70 years were studied) makes 6–27%. In process of progressing of a basic disease also strengthening диспноэ is, as a rule, observed, leading finally to restriction of physical activity of the patient and decline in quality of his life. At some diseases, for example the chronic obstructive pulmonary disease (COPD), диспноэ is one of the main factors defining the forecast of patients.

Symptoms of Dispnoe:

Диспноэ represents scale of several qualitatively various feelings. In 1981 P.Simon and соавт. offered the standardized description of feelings диспноэ, including about 20 various categories диспноэ. It turned out that many of morbid conditions of the person can be associated with certain clusters of the description диспноэ.
  The association of individual qualitative descriptions диспноэ with various diseases is characterized by the following features:

    * plurality (each disease is associated more than with one qualitative feeling);

    * uniqueness (a unique set of qualitative descriptions is characteristic of each disease);

    * overlapping (various diseases can have the general qualitative descriptions диспноэ).

Reasons of Dispnoe:

Диспноэ differs from other feelings of the person in the fact that still it is practically not known through what nervous structures there is implementation of this feeling. So, receptors диспноэ are not defined, it is not enough data on a cortical projection диспноэ. Besides, studying of a problem диспноэ considerably is complicated by the fact that there are certain difficulties of exact definition of the physical incentive causing диспноэ. For example, when developing short wind at the patient with emphysema of lungs during an exercise stress at the present stage it is almost impossible to differentiate what incentive makes the greatest contribution to development of this feeling – increase in work of breath, resistance of respiratory tracts, a hyperinflation of lungs, dysfunction of respiratory muscles or disturbance of gas structure of an arterial blood.
  Thus, диспноэ is the complex feeling resulting from stimulation of various peripheral receptors and activation of the highest centers of the central nervous system (CNS). Afferent impulses extend on spinal nerve pathways as a part of sympathetic and parasympathetic nerve fibrils.
  According to Peiffer and соавт., who studied a regional brain blood stream by means of positron emission tomography at healthy volunteers during creation of additional load of the breath device, such structures as the right front insula, vermis cerebellaris and average departments of the bridge can be possible zones of a cortical projection диспноэ, and the feeling of intensity of respiratory discomfort can be connected with activation from one of zones of limbic system – back department of gyrus singulatus.

Treatment of Dispnoe:

Knowledge of pathophysiological mechanisms диспноэ helps to approach therapy диспноэ at various morbid conditions. For example, at the diseases which are characterized by bronchial obstruction (bronchial asthma, HOBL, a mucoviscidosis) therapy of bronchodilators (b2-agonists, antikholinergik, theophyllines) allows to reduce considerably диспноэ at these patients.