Dr Aditya Agrawal on Breathlessness in Seniors (दमा)

Added: 2026-05-24

[00:00:00]Let's make it easy for everybody now.

[00:00:03]>> Okay. No, no, that's just let's reconfirm it.

[00:00:09]>> Does does work get you to or does your work or personal life get you to Punea ever?

[00:00:15]>> No, not come to Punea in a long time.

[00:00:17]The last I came was in December 2023.

[00:00:21]>> Aa >> but yes it I would love to keep coming back to Punea.

[00:00:26]>> You know I live there now. Yes, I've been there for a couple of years. No, five years.

[00:00:31]>> Four years. Four years.

[00:00:32]>> Four years.

[00:00:35]>> Good city. You know, I've now managed, you know, a decent ecosystem including medical ecosystem uh which was very >> some of some doctors are really good but that's the case everywhere you know.

[00:00:51]I guess to an extent it's everywhere.

[00:00:53]You know I have a doctor friend you may know him Maryia.

[00:00:58]>> Yes >> he's a cartoonist also.

[00:01:00]>> Yes.

[00:01:02]>> So he used to tell me he says in Bombay he used to tell me don't ever trust suburban doctors.

[00:01:10]>> And while that's so >> he said you know suburban doctors are are newer doctors. they are more interested in recovering their monies for their clinic and all those things and they give you uh you know sometimes they give you overmedicate you and all of that.

[00:01:26]>> Well let's not take it that way.

[00:01:29]>> Well many years back yeah there was some incident which happened for us and that's he then he said you know listen just be careful.

[00:01:36]>> Well that's a very uh narrow way of looking at it. Yes, there are doctors who are satisfied and there are doctors who are not.

[00:01:48]So you get a you know feel of >> who you're meeting, what is the what is in it for the other person. Some people are passionate like I will spend an hour with a patient. I'll literally sit on the bed of a patient in the hospital if I have to.

[00:02:05]And you can sense it.

[00:02:08]>> Yeah. No, true. I think also he he this was around 15 years back you know so actually what happened is my daughter was unwell and somebody told her that she has TB >> okay >> and uh you know and they got a test also done and they said TV hair and uh it wasn't you know so >> you know actually I'm seeing uh the uncle I was treating a few days ago >> uh telling you that he never felt breathless.

[00:02:43]>> He's quite an inspiration for today's talk.

[00:02:47]I won't name him. It's unethical. But I see that he has joined the uh every time I have your session, I also send one link to your father.

[00:03:11]Yeah, he'll be sitting at home right now watching it on the big tele.

[00:03:22]Uh I think the motivation for me to give these talks is that I love talking to my patients a lot.

[00:03:38]>> No and you know the thing is that they all benefit. We also I get immediate feedback you know and sometimes the feedback is there and they say no not you know not the session today was not very good and every time I have had very good feedback for your sessions as well as you know to some others so >> our audience is kind >> yeah no they give immedate feedback you know some may they give you sometimes they say okay listen you know you is going his doctor is taking so fast. I think people are people are frank in their feedback as well and see all these are senior citizens they know they have seen then they've seen life they tell you up front what they feel going to start now What is the name of your advocacy group?

[00:04:59]>> The breath first foundation.

[00:05:02]>> Okay.

[00:05:14]Yeah, please start.

[00:05:46]Heat. Heat.

[00:06:41]Hello and welcome to Health Live at Seniors Today.

[00:06:45]We are delighted to welcome here Dr. Adita Agraal. He's a leading respiratory physician. So if you've seen the montage earlier, we could actually have had uh over 12 screens of his because this is the 13th time that he is coming here. He is our favorite pulmonologist and uh we we we really uh welcome here to him here today and uh enjoy his sessions very very informative uh before I uh request him to speak Dr. Ragavaral is a leading pulmonologist attached to various hospitals in Mumbai specifically the Breach Candi and Bombay hospitals. He's extensively trained in respiratory diseases both in India and the US. His special interests are difficult to treat cough, asthma, bronchitis and lung fibrosis and runs a specialized clinic for patients with chronic cough. He's a dedicated researcher and a peer influencer in the management of respiratory diseases.

[00:07:46]Today uh you know as you know May is the uh world asthma month and dedicated to awareness. We've invited Dr. Agaval to speak about breathlessness in seniors or as they call it Dhama. Over to you Dr. Aal. Welcome.

[00:08:07]Thank you so much Mr. Maheshwari.

[00:08:12]Uh is my slide deck visible?

[00:08:14]>> Yes it is. Um I would like to thank each one of our audience for coming and logging into listen to me. Today is a topic which is very close to my heart and I love speaking about breathlessness and it is my endeavor to help our senior citizens and not just senior citizens every person in the world understand that they have breathlessness.

[00:08:40]What happens is very often when we have patients coming to our clinic with advanced lung disease, they tell us doc, how did it happen suddenly? They do not understand that they were breathless for a very long time. They were never able to understand how breathlessness manifests or they were not able to verbalize. They were not able to speak it out that they have breathlessness.

[00:09:04]They feel it's a part of aging or it's a part it's normal. And today I will help you understand what it means.

[00:09:12]Breathlessness is also called dhama sasna dham lag and when is just aging may be a actual warning sign.

[00:09:23]So today what I'm going to do is I'm going to tell you whether this breathless is a part of aging or illness. What breathlessness really means and how different people describe their breathlessness differently. What are the common causes of breathlessness and what are the warning signs in a patient who is breathless which should warrant you to seek immediate medical care. I will also help you understand what doctors do when a patient has breathlessness and they come to a doctor. It's extremely important because you should also know what to expect when you go to a doctor. I will help you understand how to live better with breathlessness and at the end I will I'm going to ask you some very difficult questions.

[00:10:08]So we have this question which we often come across a child asking or rather a a young a son asking his father are you breathless and the father will just shrug it off saying no I'm just old.

[00:10:24]This is the most dangerous sentence in a breathlessness clinic. It tells us that the patient is ignorant and is unable to gorge his breathlessness. Aging can slow us down a little. But it should not make you breathless when you are walking, talking, dressing, bathing, you know, walking from room to room or even when you're lying flat on a bed. Very often patients with breathless adapt instead of reporting their symptoms and the diagnosis gets delayed and independent shrinks quietly.

[00:11:03]So I'm going to ask these two questions.

[00:11:05]This is a scenario which we see every day in my clinic. A child comes and says my father or my mother no longer goes to the temple down the road but he or she is saying that I'm fine.

[00:11:17]Yes. Self-restriction is often the first hidden sign of breathlessness.

[00:11:24]And then you may have another patient saying, "My parent sits under the fan even in the biting cold winter." What this actually means is that the parent who breathless has air hunger and sitting in open air or under a fan helps them feel less breathless.

[00:11:51]So what is breathlessness?

[00:11:53]Breathlessness is called destnia in the medical terminology.

[00:11:57]It is a symptom. It is not a disease. So there is no one medicine for breathlessness. It is a way a disease presents to you and to a doctor. Just like pain, breathlessness is a body's alarm signal saying that something is wrong in the body. It tells us that we must look for a cause and never treat breathysis without knowing the cause.

[00:12:24]It's personal. Only a patient truly feels it. No other person can feel it for him. There is no single correct way to describe breathlessness or air hunger and especially in elderly patients or patients above the age of 60 persistent breathlessness deserves proper evaluation.

[00:12:46]Now what is breathlessness?

[00:12:48]Breathlessness is an uncomfort a feeling of discomfort while breathing. A normal person does not know that he or she is breathing. Breathing is a very easy task. But when somebody is breathless, he or she makes extra physical effort to breathe and when it becomes uncomfortable, it is called breathlessness.

[00:13:14]Now a very important question is breathlessness a part of aging or is it an illness? Does it mean that when you get old you have to get breathless? So I'll just go through what really happens here. What does age do to your lung? The lungs are like elastic balloons and the chest wall that is the thoracic cage your ribs they open up with each breath and they shut when when you exhale.

[00:13:47]Now when you age you'll realize that the lung elasticity reduces the chest wall that is your ribs do not open and close as much and when you have certain conditions such as a bent spine it becomes even worse or when somebody is extremely obese what happens is the abdominal fat pushes the diaphragm upward not allowing the diaphragm to move down or the lungs to expand with each breath.

[00:14:18]Now what else happens with aging? The exercise capacity starts reducing gradually. The heart rate reserve is lower than a younger person and a patient may not be able to tolerate high altitude.

[00:14:35]So when you're younger or whenever you are doing extra excessive work your brea the rate of breathing increases it there is a saying that if your body temperature increases by 1° Fahrenheit your breathing will increase by a ratio of four and your heart rate will increase by a factor of 10. out here.

[00:14:57]What happens is when you get older, your heart rate does not increase as much and your breathing does not increase as much as it should. So what happens is you become uncomfortable and you get breathless. And how does it feel when you're aging? Your breathing may slow down especially when you're climbing stairs or uphill.

[00:15:22]You may need more pacing on stairs. That means you may have to slow down when you're going up the stairs. You may not be able to walk as fast as earlier. You may slow down there. And higher altitudes may make you feel tougher.

[00:15:38]That means high altitude or when you are at a height breathing may become very laborious.

[00:15:47]When is breathing not normal?

[00:15:51]When you are breathless when you walk from your bedroom to your kitchen or when you're breathless while talking to someone or when you are breathless while sitting down or any breathlessness which wakes you up from sleep with gasping or if your lips are turning blue, you have a swelling on your ankle or you have chest pain. Anytime you have these signs that means your breathless is not is abnormal.

[00:16:21]Now I'll explain to you how breathlessness word or asma is so commonly misinterpreted and we use the Hindi word for it dharma. But dharma actually actually means that you are breathless. It has it can be you can use the word breathlessness in different um Indian languages such as in Hindi you call it dhama in Udu you call it sas fna in marati you may call it dham lto in Gujarati you'll say shwash in Bengali excuse me for my pronunciation in Bengali you may call it shwashoto in Tamil it is Moital and so on and so forth. Excuse me for my Telugu and Canada. It's extremely difficult to pronounce that.

[00:17:18]So it's different dialects have the same critical pathology that is breathlessness.

[00:17:25]Now another important thing is breathlessness is often explained or described as tiredness. However, you should understand that the two are completely different. Breathlessness is itself a feeling of difficulty in breathing. You may find the chest to be very tight or you may feel that you've had unsatisfactory breathing or you're not satiated when you breathe.

[00:17:54]Where is it felt? Breath this is felt in the chest, in the throat and sometimes in the airways. And the patient may say I cannot get enough air.

[00:18:06]When does it occur? Breathlessness. It can happen at rest. It can happen at night or it can happen with little activity also. How is it relieved? It is not fully relieved by rest. However, physical exhaustion improves with rest, food and sleep. And breathlessness is often associated with wheezing or a cough or chest tightness, swelling in the feet or you may have palpitations.

[00:18:32]Whereas physical exhaustion is usually associated with yawning, sore muscles and sleepiness.

[00:18:41]Breathlessness may actually reflect a serious heart or a lung condition and often it requires proper medical attention. Physical exhaustion usually is not an emergency unless it is persistent. And at that point in time you may seek medical attention.

[00:19:00]So this is a very important slide which I want everybody to listen to. What is breathlessness and how do you know how breathless you are? A normal person can do some amount of strenuous exercise without feeling breathless.

[00:19:16]But when a person feels breathless on climbing a few stairs or a little uphill or is running on flat ground and is complaining of breathlessness that is grade one breathlessness.

[00:19:32]Grade two breathless is when somebody is walking slower than his peers or stopping after about 100 m.

[00:19:41]That is grade two. Grade three is when somebody is stopping after every few minutes of walking on a flat ground and when you are too breathless to leave the home or during activities of daily living such as dressing or bathing that mean that's grade four breathlessness and you should seek immediate medical attention.

[00:20:05]Now what happens is patients who are breathless have are usually breathless for a very long time. The first thing that happens is they stop doing things which the outdoor activities that they used to such as going to a park to a gym or to a temple because it feels far.

[00:20:25]The next step that happens is they start walking slower and slower. So when you see a elderly couple walking and you see that one of them is lagging behind that is the first sign that that person who's lagging needs medical attention. He'll often say you walk ahead I'll walk slowly. That means that patient is breathless and you need to take him to a doctor. And then finally what happens is the patients adapt themselves into complete functional atrophy where mo the movement is restricted to being in bed in a chair and they only go to the bathroom and do essential chores otherwise they do nothing more because they are too breathless breathless to do anything else.

[00:21:12]The most common causes of breathlessness in elderly are asthma, COPD and such patients may complain of wheezing of a cough which is which has a whistling note to it or they may have a history of use of inhalers in the past.

[00:21:31]The second most important cause of breathless in elderly is heart failure and other heart troubles such as rhythm problems where the patient may complain of breathlessness on lying down flat.

[00:21:43]They may complain of swelling in their feet or they may have graut or palpitations which are all indicators of heart failure. Another very important symptom here is the patient may have sleep apnea and they may also present with complaining of breathlessness on lying down or sleeping.

[00:22:07]Elderly patients tend to eat less. Their nutrition is often wavered. They may not get enough green leafy vegetables and they comp will complain of fatigue or may appear very pale or may get tired with simple little activities and often times you have to look for anemia or low hemoglobin in such patients.

[00:22:33]Obesity is another very important factor in the elderly being breathless especially in India where the elderly do little physical activities where you may have joined families and it is expected the elderly will rest while the younger members of the family will do the jobs. So because of lack of activity they become less fit. Small exhaustion leads to intolerance and also because when they are ill they are expected to rest. They may become deconditioned in doing activities which makes them breathless when they perform those.

[00:23:16]Another very important thing is interstitial lung disease or lung fibrosis and we are seeing more of it each day. The patients will usually complain of a dry cough or may complain of progressive exhertional breathlessness which basically means that they may complain of breathing which is getting worse over years and if it is a very rapidly progressive lung fibrosis it may even be over few months.

[00:23:48]Another important factor is sleep disordered breathing and anxiety. So patients who are snoring, who have poor sleep, who wake up with the panic or who have unsatisfactory breathing should often check themselves for sleep apnea and for anxiety related disorders.

[00:24:13]Now in India we use the word dharma so frequently and we always think that anybody who breathless has asthma and should take inhalers. works both ways that when you have a elderly person coming with breathlessness it is assumed that they will be given inhalers and nebilization.

[00:24:31]So often times we find that in the hospitals every breathless patient is given nebilization irrespective of whether they need it or not. The other important thing is when we get younger patients with asthma, it is equated with dharma of the elderly and patients and families tend to give up on such patients saying that when you have asma or dharma as a child it means you're going to have a very poor quality of life which is absolutely false. So often we have found that patients who younger patients with asthma are denied the right treatment because it is expected that they will be breathless throughout their life which is absolutely wrong.

[00:25:17]Now breathlessness can be spoken in different words like havaki kami where people assume that's only ama but it could also be COPD that's chronic obstructive pulmonary disease heart failure or lung fibrosis the quiet red flag should be a dry cough swelling in the feet and a history of exposure to tobacco smoke or woodchula exposure.

[00:25:48]Now, kamori or tiredness is attributed to aging, but it can also be because of conditions such as anemia, irregular heart rate, and hypoventilation, which basically means your lungs are not expanding with each breath. What you should be looking for here is paleness of the skin, a fluttering chest, that means a patient may complain of gabrahat. and look for early morning headaches which is a sign of hypoventilation which means your lungs are not expanding enough.

[00:26:20]Another very important sign is chest tightness where patients come with their palm open on their chest saying I feel tight in my chest here and they often attribute it to acidity or gas which is absolutely wrong. What can happen here is it can be a sign of a heart disease or it can be a sign of increased pressure between the heart and the lung and very often it can be a sign of a specific type of ama which we call small airways disease where the smallest tubes of your lung the bronchi are constricted and a lot of air is trapped inside your lung. The patient what you should be looking for here is you should look for exertional pain. That means when they have chest pain after exerting more often than not it would indicate that the patient is having a heart problem or they may have fainting or they may have arm discomfort. And when you're looking at arm discomfort you're looking at the inner side of your left arm or your left shoulder.

[00:27:28]Now this is a topic which is very close to my heart and I thoroughly enjoy and I'm passionate about identifying more and more patients with interstitial lung disease or lung fibrosis and the endeavor is to improve their quality of life pick up the disease as soon as possible and what's happening in lung fibrosis is very important to understand healthy lungs are soft and elastic and with each breath they open and close. But in interstitial lung disease what happens is that the soft lung tissue is replaced with a scar tissue a hard tissue. The lungs become stiff. They do not open and close like a normal regular balloon. The patient will complain of a dry cough will not produce any bulg. And sometimes you may have progressively worsening or slowly worsening breathlessness and that is indic an indicator of a progressive pulmonary fibrosis.

[00:28:35]Dry cough for months and reduced oxygen after they walk are very important signs of lung fibrosis.

[00:28:48]Now this is important. What are the danger signs which a person should look for when they have breathlessness? Look for chest pain, faintness, fainting. Look for palpitations or gabrahat.

[00:29:03]When they walk, if they suddenly feel that they're getting breathless while walking or while talking or even at rest, it means that they need to see a doctor immediately. Elderly patients should always look at the ankle. If they have a new swelling in the ankle along with breathlessness, they should seek a medical consult immediately. I think the old age thing of the younger people touching the feet of the elderly was actually to understand if they have new ankle swelling because it is so commonly seen and missed that we often have delayed diagnosis of heart failure because of this ankle swelling then you should be looking for blue lips or blue fingers or very low oxygen reading. So what co did for us was that it introduced the whole society to a small device called an oxyter which reads the oxygen level. And now you may find one oxyter in almost every family across the country.

[00:30:10]Patients who wake up gasping for breath or need extra pillows and cannot sleep flat on the bed or they require two or three pillows to sleep are the ones who should seek medical consults.

[00:30:24]And patients who have sudden severe breathlessness which has happened over hours to days should also see a doctor.

[00:30:34]Now when a patient comes to a doctor, what does a doctor do? The first thing he does very patiently is listens to your story. When did your breathlessness start? What worsens your breathlessness?

[00:30:50]How does your breathlessness get better?

[00:30:53]Do you smoke?

[00:30:55]Are you able to sleep well? Do you have a swelling? Or do you have any other symptoms which go along with your breathlessness such as coughing or palpitations or fainting episodes?

[00:31:12]Then the patient the doctor will slowly examine you. He'll start with your nose.

[00:31:17]He'll examine your throat. He will check your pulse. He will put oxyter and check your oxygen levels. Then he will slowly listen to your breathing. the chest sounds. He will check for swelling on your ankles and he will look at your eyes especially the conjunctiva the inside of your eye to look for signs of anemia if there is a pale skin.

[00:31:47]He will order a few very basic blood tests which are absolutely essential.

[00:31:52]ECG to rule out any kind of heart disease. A simple chest X-ray to rule out any kind of major pneumonia or any opacities in the lung or even air collecting around the lung. He will order blood tests such as CBC which will tell us about your hemoglobin level. Or he may ask you for a certain blood test with regards to your allergies like serum Ig.

[00:32:22]If he suspects that you may have an obstructive airway disease such as am asma or COPD or even lung fibrosis, he will ask for a specific test such as spyometry, lung volumes.

[00:32:37]He may even ask you for a 2D echo to tell us about your functioning of the heart. And then when you tell him that you know your oxygen levels are falling he may actually make you do a 6 minute walk test which is walking for about 6 minutes and checking if there's a drop in your oxygen level from the prewalk time to the postwalk time. At the same time a doctor will look at more advanced numbers where he will look at your heart rate. Is your heart rate increasing while you walk? Is it increasing appropriate to your speed of walking? Or he will look for how much time it takes for your breathing and your heart rate to come back to normal after after your walk.

[00:33:29]Now after a clinical diagnosis is made, a doctor may do some advanced tests to back up his initial clinical diagnosis where he may order a CT scan of the chest. Patients with snoring and choking in their sleep, the doctor may order a sleep study. Now patients with lung fibrosis often require a special test called diffusion testing which tells us about how much oxygen that he or she is breathing in is absorbed into the blood.

[00:34:05]And very often when patients undergo certain surgeries, especially the elderly, you may want to know what is their cardiac and respiratory reserve and if they are fit enough to go under the general anesthesia.

[00:34:24]So we do something called the cardopulmonary exercise testing for them.

[00:34:33]Now there are simple selfch check questions and I think today I will ask each one of my audience to ask yourself this question. Do you get breathless while walking from one room to another?

[00:34:48]Once we break into the question and answer session I'm going to ask each one of you. Do you stop on stairs to breathe?

[00:34:57]Are you able to sleep flat in your bed or do you require several pillows to sleep on comfortably?

[00:35:04]Have you woken up at night gasping for air or breath with breathlessness such that you had to run to the window to get get some air or have you required the fan on the full speed to feel better or have the air the draft of the air conditioning fall on your face to breathe better?

[00:35:26]Has somebody noticed that you sound breathless or short of breath?

[00:35:34]Are you able to do things which made you happy such as walking, exercising?

[00:35:40]Have you not been able to go to work because you were breathless? Has breathlessness limited your activities?

[00:35:50]Do do you feel breathless when you have chest pain or dizziness or gabrahat or a racing heart?

[00:35:57]And is your breathlessness the same as it were weeks or months ago or do you think it is worsening with time?

[00:36:10]Now to live better with breathlessness, always have your breathlessness completely evaluated by a doctor.

[00:36:18]take medicines correctly and if you think that you aren't taking your medicines correctly or your breath this is not getting better always go back to your doctor and have your inhaler techniques checked take your heart medicines regularly and if you do not understand please go back the doctors would be very happy to help you there a very important message for the elderly is keep moving safely every elderly person should keep walking every day. Do certain exercises especially exercises to strengthen your proximal muscles.

[00:36:57]That means your muscles of the arm, the muscles of your thigh and the muscles of your buttock. And when I say that, why am I saying that? The simple act of lifting a glass of water requires your muscles of the arm.

[00:37:13]When you age and you are breathless and you become sedentary, your muscles start atrophing or start becoming pulpy.

[00:37:22]So the simple act of picking up a spoon and digging into your food becomes a task. And you see that elderly patients often have very poor appetite.

[00:37:37]Excuse me. Then another very important thing is elderly patients become bed bound or they have reduced mobility and that is because they have very very weak muscles of their thigh and buttock.

[00:37:53]The simple act of getting in and out of a chair or bed requires these muscles.

[00:37:58]So I request everyone here like I do to for all my patients in the clinic do your chair exercises. get in and out of a chair without support and keep increasing the frequency of this so that you strengthen your muscles better.

[00:38:16]Another very important thing that I've been doing off late is I'm asking my patients to wear these exercise watches to track the pattern track how much they're walking if their watches have oxygen readings we check their oxygen numbers over time. Then another important thing is just keep a mental note of what triggers your breathlessness. Have you feel felt more breathless when you're lying flat? Have you required increasing number of pillows?

[00:38:47]Or look at your oxygen readings. Do you think that the oxygen levels are falling when you walk? Or is your oxygen level at rest falling which it is never?

[00:38:59]And whenever you see there's a change in the symptom, see your doctor.

[00:39:05]Very often I get patients in my clinic telling me that oxygen of 92 93 94 95% is normal which is wrong. What you should understand is a satur o oxygen saturation 97% 98% and 99% indicate that there is sufficient amount of oxygen to supply the vital organs in your body. But when your oxygen reduces from 97 to 96, it means there's a problem. The total amount of oxygen available to your vital organs to function is starting to reduce. So 9 oxygen saturation of 97% is normal whereas 96 is abnormal.

[00:39:54]Now another important thing for living better with breathlessness is to protect your sleep.

[00:40:00]Treat your snoring, sleep apnnea. Avoid late night meals. Try eating at least two to three hours before your bedtime, especially if you have conditions like reflux and aspiration.

[00:40:16]Correct your anemia.

[00:40:19]Seek help to lose weight.

[00:40:24]Now I want to bust a myth which is extremely important.

[00:40:28]A patient comes to you says I'm feeling breathless.

[00:40:32]And then he will brush it off saying, "I'm just getting older. Of course, I will feel breathless."

[00:40:38]Do you think this is correct? No, it's wrong. Because normal aging causes only a mild drop in the exercise reserve. It does not cause breathlessness at rest or with simple activities.

[00:40:53]Breathlessness while doing activities such as dressing, talking or climbing even one flight of stair are not normal and not a part of routine aging.

[00:41:06]An early diagnosis improves quality of life, treatment response and independence which elderly thoroughly seek.

[00:41:16]The best person to identify breathlessness is a family member because they are the first person persons to notice that the patient has a problem even before the patient admits it.

[00:41:31]All right, I'm going to ask you questions.

[00:41:34]Okay, this is open to everybody. Anybody can interrupt and answer this question.

[00:41:41]Mr. Sharma becomes breathless every time. Mr. Sharma becomes breathless every time she walks from her bedroom to the kitchen. The distance is only about 15 m.

[00:41:51]It has been happening for the past 3 months. She says, "I thought this was my age, doctor.

[00:41:57]How breathless is the patient? Does she have grade one breathlessness, grade two, grade three, or grade four or grade five as we have it here?

[00:42:16]So you have the answer here. It is grade three breathlessness or rather grade four where she has to stop to breathe even when she is doing activities of daily living like walking in the home.

[00:42:32]Now, which of these descriptions should make one rush to an emergency room of a hospital immediately?

[00:42:41]When a patient is breathless while climbing stairs for the past 6 months or he has sudden breathlessness with severe chest pain which started about 30 minutes ago or a person is breathless after eating a very large meal which will settle with rest.

[00:42:59]or should a person who has been running since childhood and now complains of breathlessness should rush to an emergency?

[00:43:09]Yes, the answer is sudden breathlessness with severe chest pain which could indicate that the patient is having either a heart attack or a condition called a pulmonary emolism or lung attack. Do not wait here. Rush.

[00:43:28]Now, now these are the true and false statements. Okay? Breathless in a 70 year old is usually just normal aging.

[00:43:36]No. And if anybody is saying true even now after the whole talk, we'll need another round of this talk.

[00:43:47]So, does using extra pillows to sleep indicate signs of an early heart failure? Yes, it may.

[00:43:57]Does anxiety can cause breathlessness that feels completely real and physical to the patient? Yes. Anxiety is a condition in which the patient is overthinking and anxiety brings along hyperventilation or the patient may breathe very fast and so fast that he is feeling uncomfortable or getting tired breathing.

[00:44:21]Then does breathlessness with blue lips or rather should a person who is complaining of breathlessness and has blue lips wait until next morning to see a doctor?

[00:44:36]No. When a person has blue lips with breathlessness, it indicates that the patient has very low oxygen levels in the blood.

[00:44:50]Can stopping smoking improve breathlessness in a patient with COPD even in those who have stopped smoking after 40 years of smoking. No, there you may have something called chronic breathlessness syndrome.

[00:45:09]Another question, Mr. Meta who 68 has been breathless for the past 3 months.

[00:45:15]His doctor has prescribed him an inhaler.

[00:45:20]He's a little better but still gets breathless when dressing himself every morning. His ankles are swollen and he his shoes don't fit him well.

[00:45:30]He has been using his he has been using two large pillows to sleep upon.

[00:45:36]What should he do? Be happy that the inher is helping a little and just continue. go to a doctor immediately and mention the persistent breathlessness, ankle swelling and extra pillows or stop ins because it is not helping him enough or wait for another few months for things to get better. Yes, the answer is very obvious that he should immediately go to a doctor. This could possibly be because of heart failure or even conditions such as asthma and COPD.

[00:46:10]Never accept ongoing symptoms. Never accept symptoms which are happening right now.

[00:46:16]Always report symptoms to your doctor.

[00:46:22]Now I'm going to ask you to match these.

[00:46:24]Okay. Breathlessness on lying down flat which gets better on sitting up is associated with correct heart failure.

[00:46:35]Breathlessness only when breathing in.

[00:46:39]Noisy inhalation is due to vocal cord dysfunction or voice box dysfunction.

[00:46:46]Breathlessness mainly during the night after falling asleep is due to sleep apnea.

[00:46:55]Breathlessness with chest tightness which gets worse during cold weather is because of asthma.

[00:47:02]and you have breathlessness with tingling in the fingers after a shock or a scare would indicate anxiety or hyperventilation.

[00:47:12]So another important thing to remember is when you have patients with breathless who have very stiff fingers and who complain of tingling in their fingers often have hyperventilation that means they're breathing too fast which is causing that All right. So now another another exercise that we need to do is distinguishing breathlessness from exhaustion.

[00:47:44]So a person who has walked 5 kilometers in the afternoon sun will feel tired and need to rest. Such a patient has exhaustion.

[00:47:55]While a person who's climbing only one flight of stairs and getting breathless may have chest tightness and breathing may become labored, such a patient has breathlessness.

[00:48:08]A person who come who feels very tired after a poor night's sleep will have exhaustion.

[00:48:17]Whereas somebody who's sleeping and wakes up in the middle of the night to breathe will have breathlessness and needs to see a doctor immediately.

[00:48:28]It's important to understand that breathless is not a character flaw.

[00:48:33]It is not something that every elderly should have or it is not negotiable to have breathlessness.

[00:48:42]It is important that all our patients notice breathlessness early, find the cause, name the cause and seek help promptly.

[00:48:55]Thank you. I'll be open for questions now.

[00:48:58]>> Thank you very much. Thank you very much uh doctor for an amazing and comprehensive presentation. Uh quite a few questions have come in. I'll just look at what's uh you've not answered.

[00:49:14]Uh uh there's a question from Shamla Rabi who asks what is the first stage for breathlessness before reaching the doctor.

[00:49:28]Well, anytime that you aren't able to breathe well, which would mean that activities which you could do the previous day and you suddenly can't do today would mean that you're breathless or your breathlessness is worsening.

[00:49:44]Grade one breathless as I explained earlier and I'll explain it once again is when you are finding it difficult to climb stairs or you get breathless while climbing stairs.

[00:49:56]Grade two, breathlessness is when you are walking slower than your peers.

[00:50:02]Suppose you go for a morning walk with your friends who are probably of a similar age and suddenly you are falling behind or you're walking slower than them. That's a indicator that you should go seek help.

[00:50:17]Third is when you have to stop after every 100 steps to gather some breath or you have to stop to breathe after every 100 steps or less. It means that you have grade three breathlessness.

[00:50:31]And then when you have breathlessness on doing activities of daily living such as walking in the house, you take it for granted that you can comb your hair, dress yourself up, have a shower.

[00:50:43]But if these things are making you breathless, you know, you need to see your doctor immediately.

[00:50:50]That's your different grades of breathlessness. I hope this answers your question, Mr. It does. Thank you.

[00:50:57]There's a question from Sushma Araal who asks who says or So another very important thing that we should remember is breathlessness while talking on a phone or breathlessness when you're eating may indicate nasal obstruction.

[00:51:33]There are several nasal conditions ranging from allergic rhinitis, polyposis etc. which can cause nasal obstruction and breathlessness.

[00:51:45]It is important that your doctor examines your nose every time you complain of breathlessness because simple things like clearing your nose or reducing your nasal allergies can actually ease your breathlessness.

[00:51:59]>> Right.

[00:52:00]Uh there's a question which is uh from Suna Verma who says the hot weather uh the hot weather makes her very uncomfortable should she consult a doctor and I guess it's concerning a respiratory issue so is there a linkage between this weather and uh and breathlessness doctor >> uh it's very difficult to say But what happens is when you are feeling hot, you want a draft of air on you and that can also make you feel uncomfortable.

[00:52:40]Uh it may be difficult to assess but yes you should see a doctor if you are feeling breathless and when I again go back it may be heat exhaustion.

[00:52:52]Look at your activities. Are your activities limited because of your breathlessness? Are you finding it difficult to exert yourself or climb stairs? Are you walking slower? Go back to those questions and if that's happening then you know it is true breathlessness and you should seek a medical consult.

[00:53:12]>> Right? There's a question from Paramjit Kore who says uh she yawns frequently and watery eyes.

[00:53:20]Is there something to worry about?

[00:53:23]Well, it's not something to worry about, but when you have frequent yawning and you have itchy, watery eyes, it would indicate that you have allergies.

[00:53:34]And yawning may just indicate that you have nasal obstruction or you may have sleep apnea or that you're not body is not getting enough air to breathe and you should seek a doctor consult for such a condition.

[00:53:49]And uh doctor there's a question which has come from Nina Goel any household methods for uh for this for breathlessness for asthma.

[00:54:01]There is no household method for bre relieving your breathlessness. You should first identify the cause of your breathless and then treat it. Now if you know the cause of breathlessness and there may be certain means to help you feel better even at home before you reach a doctor. Simple example you know that you have COPD or you have asthma and you have chest tightness. You know what you have to do. You you have air stuck in your lung. You need to ease eek that air out. So you sit down and p your lips like this and blow. Blow as if you're blowing candles on a birthday cake. By doing that one simple activity, you will exhale out air which is stuck inside your lung and this will help you with your breathing.

[00:54:54]>> Right.

[00:54:55]>> Thank you very much doctor. We've exceeded time. I'm sorry 5 past 5:45.

[00:55:01]Uh thank you once again for being here.

[00:55:04]Uh Dr. Dr. Adavar for taking uh a session you've been doing the session on uh asthma at least once a year for the last four years and u once again uh you know as as the various messages are saying and we have u we've had almost 200 people here plus a lot of people on live on YouTube uh all thanking you for your amazing presentation look forward to seeing you alone again and uh look forward to uh your writing as well uh on uh on the Seniors Today uh website and on in our magazine. Thank you once again >> and we will be back once again next Saturday at 5:00 PM for another session of Health Live at Seniors Today. Do check out our various activities on Evergreen Club as well as on the Seniors Today website. Thank you again. Thank you very much. and cube.