Komplexe Differenzialdiagnostik - Erstdiagnostik und Therapie der Dyspnoe aus Sicht des Pneumologen

Die derzeitig beste Theorie über die Entstehung einer Dyspnoe ist die Dissoziation zwischen dem Atemantrieb und der afferenten Rückmeldung über den Erfolg dieser Atemstimulation. Sauerstoffmangel für sich alleine führt nicht zu Atemnot - eines der Kardinalsymptome der meisten bronchopulmonalen Krankheiten. Doch trotz der vielfältigen Differenzialdiagnosen gelingt es in der Regel bereits mit der Anamnese und mit wenigen technischen Untersuchungen der endgültigen Diagnose sehr nahe zu kommen. Bei einer Belastungsdyspnoe ohne weitere relevante Begleitsymptome beispielsweise kann ein Lungenemphysem, eine idiopathische pulmonalarterielle Hypertonie oder eine Schwäche der Atemmuskulatur zugrunde liegen. Besonders bei den obstruktiven Atemwegskrankheiten und dem Lungenemphysem spielt die Überblähung der Lunge mit der Folge einer verminderten inspiratorischen Kapazität (IC) bei der Abschätzung einer Dyspnoe eine wesentlich größere Rolle als das Einsekundenvolumen bei forcierter Exspiration (FEV1). Wenn es nicht gelingt, die Dyspnoe durch die Therapie der Grundkrankheit zu lindern, kommen unter bestimmten Voraussetzungen eine Behandlung mit Sauerstoff, ein Belastungstraining oder auch Opiate infrage.

The currently best theory on the development of dyspnoea is that there is dissociation between the respiratory drive and the relevant afferent feedback. A lack of oxygen alone does not lead to respiratory distress, one of the cardinal symptoms of most bronchopulmonary diseases. Despite the diversity of differential diagnoses, the case history and a few technical examinations usually suffice to come very close to the final diagnosis. In the case of dyspnoea of exertion with no further relevant symptoms, for example, the underlying problem may be pulmonary emphysema, idiopathic pulmonary hypertension, or a weakness of the respiratory muscles. In obstructive airway disease and pulmonary emphysema, overinflation of the lungs resulting in a reduction in the inspiratory capacity (IC) has a much greater role to play in dyspnoea than the forced expiratory volume in 1 second (FEV1). If treatment of the underlying disease fails to ameliorate the dyspnoea, treatment with oxygen, exercise training or the use of opiates may be considered.

Key Words

dyspnoea - airway disease - pulmonary emphysema - pulmonary hypertension - chronic obstructive bronchitis - inspiratory capacity - FEV1

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