The genesis of breathlessness What do we understand?
Breathlessness or dyspnoea in the clinical situation varies from one individual to another. Thus, a clinician must take a comprehensive physiological view of each patient when evaluating the cause of breathing discomfort. This chapter provides an overview of the multiple physiologic processes that contribute to the sensation of breathlessness. In general, the natural progression of cardiopulmonary disease to breathlessness is a slow progression marked by superimposed acute episodes and physical changes. Whilst sensation such as pain is initiated by a single receptor, breathlessness is caused by the complex integration of information from multiple receptors in the entire respiratory system. Information from these receptors in the airways, lungs, chest wall, and chemoreceptors is processed along with the sensory receptors associated with motor output from the cortex and the brainstem. This process results in discomfort in breathing or dyspnoea. Dyspnoea has multiple qualitative distinct sensations. For instance, receptors in the lung parenchyma may give a sensation of tightness and chemoreceptors a sense of air hunger. These qualitative descriptors give an insight into the underlying factors that cause breathing discomfort in patients. Hence, knowledge of the different mechanisms responsible for debilitating breathlessness is very crucial in order to design effective treatment strategies for patients.
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