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“3" RESPIRATORY CAUSES OF DYSPNOEA ON EXERTION
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Although, in the medical colleges, it is stressed that the symptom of dyspnoea on exertion is synonymous with onset of cardiac failure, in practice I have found that CCF is the rarest cause of dyspnoea on exertion.The most common “3" causes of dyspnoea on exertion are:-
1. Anaemia
2. Obesity
3. Poor physical conditioning - due to inadequate regular exercise or sports..
In this article, I would like to draw the attention of the family physicians to “3" respiratory causes of this symptom. These are:-
1. COPD
2. Exercise Induced Bronchial Asthma
3. ILD (Interstitial Lung Disease)
You only need to elicit the history of smoking to diagnose COPD.
Past or present history of allergic rhinitis (excessive sneezing and profuse watery nasal discharge), family history of respiratory allergy and history of spells of cough, wheezing or sneezing precipitated by - house dusting, masala smell, smoke, painting, pest control, cold drinks or laughing are all in favour of exercise induced bronchial asthma.
Finally, if a young man or a woman develops dry cough, increasing dyspnoea on exertion and severe loss of weight within a few weeks or months, the patient has ILD. Clinically, evidence of central cyanosis with or without presence of clubbing and basal crepitations would clinch the diagnosis.
Practitioners who possess “pulse oxymeter”, could diagnose this condition much before clinical cyanosis appears. In fact a normal SPO2 would exclude ILD.
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