July 05, 2013
By Robert H. Shmerling M.D.
Beth Israel Deaconess Medical Center
Let's face it: breathing is important. This column wouldn't last more than a line or two without it.
Breathing is also familiar. You breathe in, you breathe out. Sometimes you breathe faster than other times. If you're a healthy person, that may be about all you need to know.
Even though we may not think much about breathing (until problems arise), its importance is clearly reflected in how the act of breathing has made its way into figures of speech:
- That painting left me breathless.
- The view from the mountaintop was breathtaking.
- I was waiting for her answer with bated breath.
Each of these refers to a loss of breath: when considering something of major impact, the speaker has (figuratively) stopped or reduced his or her breathing.
When your doctor talks about breathing, he or she may use a variety of terms. For example, "respiration" or "ventilation." Or your doctor may say "pulmonary" for anything related to your lungs. There are even less familiar words your doctor may use. Here's a look at them.
Back to top
Terms for Breathing
A number of medical terms about breathing come from the Greek words. Some common examples include:
- Dyspnea — This means shortness of breath or discomfort while breathing. It comes from the Greek "dys," which means abnormal and "pnoia," which means wind or breath. It's a condition that can be difficult to describe. Some people will say their breathing is "heavy" or "labored" while others say they can't get enough air (also called "air hunger"). All of these are considered forms of dyspnea.
Dyspnea may be one of the most common medical terms that the average person has never heard of. In fact, when our hospital wanted to create a center to evaluate patients with shortness of breath, the proposed name was "The Dyspnea Center." But, it was quickly realized that people might not know what this name means. So, they changed it to "The Asthma and Dyspnea Center." Now people know it's a place for breathing problems.
- Apnea — This term comes from the Greek word "apnoia," which means "without breathing." This is where the common sleep disorder, sleep apnea (or obstructive sleep apnea), gets its name. Sleep apnea is a disorder that causes people to stop breathing for short periods during sleep.
- Tachypnea — The prefix "tachy" means fast. So this term means abnormally rapid breathing. A normal breathing rate varies between 8 and 12 times per minute (slower when sleeping, faster when exercising or excited). A doctor may consider a person to be tachypneic if he is breathing faster than 8 to 12 times per minute.
Back to top
Ventilators -- Miracle of Modern Medicine
Another common term for breathing is ventilation. It usually refers to breathing with the help of a ventilator or breathing machine.
A ventilator takes over the mechanics (and work) of breathing via a tube inserted down the throat through the mouth or nose or directly into the trachea. The machine provides oxygen-rich air and removes carbon dioxide. Modern ventilators allow adjustments in a number of important features including the amount of oxygen is delivered, how big each breath is, how much pressure the inspired air is under with each breath, and how fast breathing occurs.
Ventilator-supported breathing is usually temporary. For example, a person with pneumonia may need help breathing until antibiotics have a chance to work. In years past, many people who might have died within hours now survive only because they can be supported on a ventilator through days or weeks of serious illness.
People who have chronic conditions that impair breathing, such as spinal cord injuries (where the nerves that control breathing are paralyzed), may need to be on a ventilator long term.
Back to top
When Things Go Wrong
Doctors listen to the way air enters and exits the lungs using a stethoscope. It's part of the routine physical examination. If a person is complaining about her breathing, the doctor can hear a lot listening to the lungs. For example:
- Rales or crackles – These sounds mimic air bubbling through fluid (because that's just what they are!). They can usually be heard when a person has pneumonia, heart failure or just about any cause of fluid in the air sacs deep in the lungs. Sometimes they'll sound more like pulling two Velcro® surfaces apart (dry crackles or dry rales) and are most commonly heard during inspiration.
- Wheezes – Air that is trying to exit the lungs through abnormally narrowed small airways creates wheezes. They are usually high pitched and continue during exhalation; sometimes they can be heard without a stethoscope. Asthma is the most common cause.
- Rhonci – These sounds occur when there is a large blockage or irregularity in the airway. (Mucous secretions or a tumor can cause rhonchi.) The sounds may resemble snoring. After coughing, rhonci may disappear. A common cause of rhonci is bronchitis, though tumors, infections and other breathing disorders can also cause them.
- A rub – This loud, squeaky (or "leather-on-leather") sound is due to inflammation or irritation of the lining of the lung (the pleura). It is also called a "pleural friction rub." The sound may be heard during inspiration and expiration and may be only in one specific area. A rub suggests pleurisy (inflammation of the lining of the lung), which may be due to a condition such as infection, tumor or lupus.
Of course, the most ominous abnormal breath sound is no sound at all. This occurs when a person has stopped breathing. But lack of air movement in just one part of the lung may be associated with a tumor in the lung, fluid accumulation around the lung (a condition called pleural effusion) or lung collapse.
Back to top
The Bottom Line
Breathing is essential to life. Confusing medical terminology is not.
But, for better or worse, medical terminology is here to stay. If you want to understand what your doctor is saying, learn your doctor's language or ask for a "translation." Your doctor should already be using terms you understand, so it's not really asking too much.
Back to top
Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.