it causes an over expansion of the upper, and a recession of the lower chest. This in rachitie children produces marked deformities. <Callout type="warning" title="Warning">Asthma can lead to cyanosis and suffocation.</Callout> Expiratory dyspnea occurs in asthma, emphysema and edema of the glottis. Expiration is prolonged and laborious, the accessory expiratory muscles are called into activity. Orthopnea is exaggerated dyspnea, in which the patient is no longer able to breathe in recumbency, but is forced to sit up and frequently add the additional support of his ‘hands, in order to fix the muscles of the shoulder girdle and thus assist the accessory muscles of respiration. It is characteristically seen when the lungs are congested as the result of tricuspid insufficiency and indicates that the last line of reserve force has been called into action. Asthma is an intermittent form of dyspnea in which expiration is chiefly affected. The latter is often audible at a distance from the patient as a musical wheezing sound. When marked, it is accompanied by cyanosis, a sense of thoracic constriction and of suffocation. It is due to obstruction of the bronchi, either spasmodic or edematous in nature, and is accompanied by the expectoration of tenacious glairy mucus. Asthma is frequently an anaphylactic manifestation. Non-expansive Dyspnea.—In this type of breathing the chest is elevated but does not expand. It occurs if the lung is impermeable to air (pneumothorax), or if the thorax is already distended to the limit of its capacity (large pleural effusions, extreme emphysema) or if expansion is prevented by dense pleural adhesions (pulmonary fibrosis). Restricted or “catchy” respiration may occur in acute pleuritis or intercostal neuritis as a result of pain. Stridulous breathing is characterized by a noisy, high-pitched, crowing or whistling expiration. It is due to a spasmodic condition of the vocal cords which occurs in children. THE EXAMINATION OF THE LUNGS Stertorous breathing may be heard at a distance from the patient. It occurs in comatose and moribund patients, and consists of rattling, snoring or bubbling sounds. Its genesis is akin to that of snoring, since it is often due to vibrations set up by the soft palate, glottis, tongue or vocal cords. Not infrequently, however, it is due to exudate in the trachea or large bronchi, which is thrown into vibration by the act of breathing, as for instance in case of pulmonary edema. The death rattle is a combination of stertorous breathing combined with the rattling caused by the vibration of exudate (serum, pus, blood) in the large bronchi and the trachea. VISIBLE CHANGES IN RESPIRATORY RHYTHM Cheyne-Stokes Respiration.—This is characterized by visible irregularity of breathing. The respirations, shallow at first, gradually increase in depth and rapidity, to be followed after gradually diminishing excursions by complete apnea, lasting sometimes nearly 30 seconds (Fig. 37). It occurs in the coma of uremia, apoplexy, meningitis, opium poisoning, etc. Blood-pressure is higher during the hyperpneic periods, in case associated with increased intracranial tension. Cheyne-Stokes respiration is due to an obtunded sensibility of the medulla to CO2 and the respiratory center remains inactive until another over-accumulation of this gas has taken place. Cheyne-Stokes respiration is of grave, but not necessarily fatal, import. In children, if associated with other suggestive symptoms, it points gravely toward a meningitis. Biot’s Breathing—This type of breathing differs from that just described, in that a series of rapid but equally deep respiratory movements is followed by a sudden apnea. There is no gradual increase and decrease in the depth of respirations (Fig. 38). It may be regarded as almost pathognomonic of meningitis (Conner and Stillman’). <Callout type="important" title="Important">Cheyne-Stokes respiration can indicate a serious condition like meningitis.</Callout> 1 Conner and StituM. “4 Pneumographic Study of Respiratory Irregularities in Meningitis.” Arch. Int. Med., ix, 1912, 203.
Key Takeaways
- Recognize the signs of asthma and its potential severity.
- Understand Cheyne-Stokes respiration as a critical indicator of meningitis.
- Identify non-expansive dyspnea in various conditions.
Practical Tips
- Monitor for signs of respiratory distress, especially in children or those with pre-existing conditions.
- Use stethoscope to listen for wheezing sounds that may indicate asthma.
- Be aware of Cheyne-Stokes respiration as a potential life-threatening condition requiring immediate medical attention.
Warnings & Risks
Warning
Asthma can lead to cyanosis and suffocation.
Risk
Stridulous breathing in children may indicate a serious underlying issue like vocal cord spasms.
Modern Application
While the specific diseases discussed in this chapter are not common today, understanding respiratory patterns remains crucial for recognizing and managing breathing issues. Modern medical equipment can help diagnose conditions more accurately, but basic knowledge of these patterns is still valuable for initial assessment and emergency response.
Frequently Asked Questions
Q: What does Cheyne-Stokes respiration indicate?
Cheyne-Stokes respiration indicates a serious condition such as uremia, apoplexy, meningitis, or opium poisoning. It is due to an obtunded sensibility of the medulla to CO2 and can be pathognomonic of meningitis in children.
Q: How can one recognize asthma?
Asthma is characterized by expiratory dyspnea, prolonged expiration with audible wheezing. It may also cause cyanosis, a sense of thoracic constriction and suffocation due to obstruction of the bronchi.
Q: What are the signs of non-expansive dyspnea?
Non-expansive dyspnea occurs when the chest is elevated but does not expand. This can be seen in conditions like pneumothorax, large pleural effusions, or pulmonary fibrosis where expansion is prevented by dense pleural adhesions.