Inspiration Health Dictionary

The reverse of the normal movements of breathing (see RESPIRATION). The chest wall moves in instead of out when breathing in (inspiration), and out instead of in when breathing out (expiration). The spaces between the ribs are indrawn on inspiration – a symptom seen in children with respiratory distress, say, as a result of ASTHMA or lung infections. Patients with CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) often suffer from paradoxical breathing; and trauma to the rib cage, with fractured sternum and ribs, also cause the condition. Treatment is of the underlying cause.... paradoxical breathing

(Irish) A dream or vision; an inspiration

Aislin, Ayslin, Ayslinn, Ayslyn, Ayslynn, Aislyn, Aisylnn, Aislinn... aisling

(Armenian) From the river of inspiration

Araxi, Araxy, Araxey, Araxee, Araxea, Araxeah, Araxye... araxie

Breathlessness, or dyspnoea, may be due to any condition which renders the blood de?cient in oxygen, and which therefore produces excessive involuntary e?orts to gain more air. Exercise is a natural cause, and acute anxiety may provoke breathlessness in otherwise healthy people. Deprivation of oxygen – for example, in a building ?re – will also cause the victim to raise his or her breathing rate. Disorders of the lung may diminish the area available for breathing – for example, ASTHMA, PNEUMONIA, TUBERCULOSIS, EMPHYSEMA, BRONCHITIS, collections of ?uid in the pleural cavities, and pressure caused by a TUMOUR or ANEURYSM.

Pleurisy causes short, rapid breathing to avoid the pain of deep inspiration.

Narrowing of the air passages may produce sudden and alarming attacks of di?cult breathing, especially among children – for example, in CROUP, asthma and DIPHTHERIA.

Most cardiac disorders (see HEART, DISEASES OF) cause breathlessness, especially when the person undergoes any special exertion.

Anaemia is a frequent cause.

Obesity is often associated with shortness of breath. Mountain climbing may cause breathlessness

because, as altitude increases, the amount of oxygen in the air falls (see ALTITUDE SICKNESS). (See also LUNGS and RESPIRATION.)... breathlessness

The healthy chest is gently rounded all over, its contour being more rounded in women by the breast tissue. In cross-section it is oval-shaped with a longer dimension from side to side than from back to front.

Barrel chest is found in long-standing ASTHMA or chronic BRONCHITIS and EMPHYSEMA, when the lungs are chronically enlarged. The anterio-posterior dimension of the chest is increased and the ribs are near horizontal. In this position they can produce little further expansion of the chest, and breathing often relies on accessory muscles in the neck lifting up the whole thoracic cage on inspiration.

Pigeon chest is one in which the cross-section of the chest becomes triangular with the sternum forming a sort of keel in front. It may be related to breathing problems in early life.

Rickety chest is uncommon now and is caused by RICKETS in early life. There is a hollow down each side caused by the pull of muscles on the softer ribs in childhood. The line of knobs produced on each side where the ribs join their costal cartilages is known as the rickety rosary.

Pectus excavatum, or funnel chest, is quite a common abnormality where the central tendon of the diaphragm seems to be too short so that the lower part of the sternum is displaced inwards and the lower ribs are prominent. When severe, it may displace the heart further to the left side.

Local abnormalities in the shape of the chest occur when there is a deformity in the spine such as scoliosis which alters the angles of the ribs. The chest wall may be locally ?attened when the underlying lung is reduced in size locally over a prolonged period. (See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.) This may be seen over a scarred area of lung such as that observed in pulmonary TUBERCULOSIS.... chest, deformities of

A type of breathing which gets very faint for a short time, then gradually deepens until full inspirations are taken for a few seconds, and then gradually dies away to another quiet period, again increasing in depth after a few seconds and so on in cycles. It is seen in some serious neurological disorders, such as brain tumours and stroke, and also in the case of persons with advanced disease of the heart or kidneys. When well marked it is a sign that death is impending, though milder degrees of it do not carry such a serious implication in elderly patients.... cheyne-stokes breathing

Choking is the process which results from an obstruction to breathing situated in the larynx (see AIR PASSAGES). It may occur as the result of disease causing swelling round the glottis (the entrance to the larynx), or of some nervous disorders that interfere with the regulation of the muscles which open and shut the larynx. Generally, however, it is due to the irritation of a piece of food or other substance introduced by the mouth, which provokes coughing but only partly interferes with breathing. As the mucous membrane lining the upper part of the latter is especially sensitive, coughing results in order to expel the cause of irritation. At the same time, if the foreign body is of any size, lividity of the face appears, due to partial su?ocation (see ASPHYXIA).

Treatment The choking person should take slow, deep inspirations, which do not force the particle further in (as sudden catchings of the breath between the coughs do), and which produce more powerful coughs. If the coughing is weak, one or two strong blows with the palm of the hand over either shoulder blade, timed to coincide with coughs, aid the e?ect of the coughing. If this is ine?ective, the Heimlich manoeuvre may be used. This involves hugging the person from behind with one’s hands just under the diaphragm. A sudden upward compressive movement is made which serves to dislodge any foreign body. In the case of a baby, sit down with left forearm resting on thigh. Place the baby chest-down along the forearm, holding its head and jaw with the ?ngers and thumb. The infant’s head should be lower than its trunk. Gently deliver three or four blows between the shoulder blades with the free hand. The resuscitator should not attempt blind ?nger-sweeps at the back of the mouth; these can impact a foreign body in the larynx.

If normal breathing (in adult or child) cannot be quickly restored, seek urgent medical help. Sometimes an emergency TRACHEOSTOMY is necessary to restore the air supply to the lungs. (See APPENDIX 1: BASIC FIRST AID.)... choking

(Arabic) The heart’s inspiration... ilham

(Gaelic) Form of Aislinn, meaning “a dream or vision; an inspiration” Isleene, Islyne, Islyn, Isline, Isleine, Isliene, Islene, Isleyne, Isleane... isleen

Also known as laryngo-tracheo-bronchitis, croup is a household term for a group of diseases characterised by swelling and partial blockage of the entrance to the LARYNX, occurring in children and characterised by crowing inspiration. There are various causes but by far the commonest is acute laryngo-tracheobronchitis (see under LARYNX, DISORDERS OF). Croup tends to occur in epidemics, particularly in autumn and early spring, and is almost exclusively viral in origin – commonly due to parain?uenza or other respiratory viruses. It is nearly always mild and sufferers recover spontaneously; however, it can be dangerous, particularly in young children and infants, in whom the relatively small laryngeal airway may easily be blocked, leading to su?ocation.

Symptoms Attacks generally come on at night, following a cold caught during the previous couple of days. The breathing is hoarse and croaking (croup), with a barking cough and harsh respiratory noise. The natural tendency for the laryngeal airway to collapse is increased by the child’s desperate attempts to overcome the obstruction. Parental anxiety, added to that of the child, only exacerbates the situation. After struggling for up to several hours, the child ?nally falls asleep. The condition may recur.

Treatment Most children with croup should be looked after at home if the environment is suitable. Severe episodes may require hospital observation, with treatment by oxygen if needed and usually with a single dose of inhaled steroid or oral PREDNISONE. For the very few children whose illness progresses to respiratory obstruction, intubation and ventilation may be needed for a few days. There is little evidence that putting the child in a mist tent or giving antibiotics is of any value. Of greater importance is the reassurance of the child, and careful observation for signs of deterioration, together with the exclusion of other causes such as foreign-body inhalation and bacterial tracheitis.... croup

The simplest form of intermittent positive-pressure ventilation is mouth-to-mouth resuscitation (see APPENDIX 1: BASIC FIRST AID) where an individual blows his or her own expired gases into the lungs of a non-breathing person via the mouth or nose. Similarly gas may be blown into the lungs via a face mask (or down an endotracheal tube) and a self-in?ating bag or an anaesthetic circuit containing a bag which is in?ated by the ?ow of fresh gas from an anaesthetic machine, gas cylinder, or piped supply. In all these examples expiration is passive.

For more prolonged arti?cial ventilation it is usual to use a specially designed machine or ventilator to perform the task. The ventilators used in operating theatres when patients are anaesthetised and paralysed are relatively simple devices.They often consist of bellows which ?ll with fresh gas and which are then mechanically emptied (by means of a weight, piston, or compressed gas) via a circuit or tubes attached to an endotracheal tube into the patient’s lungs. Adjustments can be made to the volume of fresh gas given with each breath and to the length of inspiration and expiration. Expiration is usually passive back to the atmosphere of the room via a scavenging system to avoid pollution.

In intensive-care units, where patients are not usually paralysed, the ventilators are more complex. They have electronic controls which allow the user to programme a variety of pressure waveforms for inspiration and expiration. There are also programmes that allow the patient to breathe between ventilated breaths or to trigger ventilated breaths, or inhibit ventilation when the patient is breathing.

Indications for arti?cial ventilation are when patients are unable to achieve adequate respiratory function even if they can still breathe on their own. This may be due to injury or disease of the central nervous, cardiovascular, or respiratory systems, or to drug overdose. Arti?cial ventilation is performed to allow time for healing and recovery. Sometimes the patient is able to breathe but it is considered advisable to control ventilation – for example, in severe head injury. Some operations require the patient to be paralysed for better or safer surgical access and this may require ventilation. With lung operations or very unwell patients, ventilation is also indicated.

Arti?cial ventilation usually bypasses the physiological mechanisms for humidi?cation of inspired air, so care must be taken to humidify inspired gases. It is important to monitor the e?cacy of ventilation – for example, by using blood gas measurement, pulse oximetry, and tidal carbon dioxide, and airways pressures.

Arti?cial ventilation is not without its hazards. The use of positive pressure raises the mean intrathoracic pressure. This can decrease venous return to the heart and cause a fall in CARDIAC OUTPUT and blood pressure. Positive-pressure ventilation may also cause PNEUMOTHORAX, but this is rare. While patients are ventilated, they are unable to breathe and so accidental disconnection from the ventilator may cause HYPOXIA and death.

Negative-pressure ventilation is seldom used nowadays. The chest or whole body, apart from the head, is placed inside an airtight box. A vacuum lowers the pressure within the box, causing the chest to expand. Air is drawn into the lungs through the mouth and nose. At the end of inspiration the vacuum is stopped, the pressure in the box returns to atmospheric, and the patient exhales passively. This is the principle of the ‘iron lung’ which saved many lives during the polio epidemics of the 1950s. These machines are cumbersome and make access to the patient di?cult. In addition, complex manipulation of ventilation is impossible.

Jet ventilation is a relatively modern form of ventilation which utilises very small tidal volumes (see LUNGS) from a high-pressure source at high frequencies (20–200/min). First developed by physiologists to produce low stable intrathoracic pressures whilst studying CAROTID BODY re?exes, it is sometimes now used in intensive-therapy units for patients who do not achieve adequate gas exchange with conventional ventilation. Its advantages are lower intrathoracic pressures (and therefore less risk of pneumothorax and impaired venous return) and better gas mixing within the lungs.... intermittent positive pressure (ipp)

A noise associated with inspiration due to narrowing of the upper airway, in particular the LARYNX.... stridor

(Hawaiian) Born of heavenly inspiration

Ululanie, Ululany, Ululaney, Ululanee, Ululanya, Ululania... ululani

The amount of air that can be forcibly exhaled from the lungs after a deep inspiration. (See RESPIRATION.)... vital capacity

Accelerated inspiration, followed by slow expiration is usually not serious. May accompany fevers and certain nervous disorders for which no specific treatment is necessary. Where condition is chronic the causal factor should be investigated. Any underlying condition should be treated. For transient irregularity:–

Teas: Balm, Motherwort, Mistletoe, Lime flowers. Tablets/capsules. Lobelia, Hawthorn, Motherwort, Valerian. ... breathing irregularities

The volume of air within the LUNGS changes with the respiratory cycle (see RESPIRATION). The volumes de?ned in the following table can be measured, and may be useful indicators of some pulmonary diseases.

Normal values for a 60 kg man are (in ml):

Total lung capacity (TLC) The volume of air that can be held in the lungs at maximum inspiration.

Tidal volume (TV) The volume of air taken into and expelled from the lungs with each breath.

Inspiratory reserve volume (IRV) The volume of air that can still be inspired at the end of a normal quiet inspiration.

Expiratory reserve volume (ERV) The volume of air that can still be expired at the end of a normal quiet expiration.

Residual volume (RV) The volume of air remaining in the lungs after a maximal expiration.

Vital capacity (VC) The maximum amount of air that can be expired after a maximal inspiration.

Functional residual capacity (FRC) The volume of air left in the lungs at the end of a normal quiet expiration.... lung volumes

The process in which air passes into and out of the lungs so that the blood can absorb oxygen and give o? carbon dioxide and water. This occurs 18 times a minute in a healthy adult at rest and is called the respiratory rate. An individual breathes more than 25,000 times a day and during this time inhales around 16 kg of air.

Mechanism of respiration For the structure of the respiratory apparatus, see AIR PASSAGES; CHEST; LUNGS. The air passes rhythmically into and out of the air passages, and mixes with the air already in the lungs, these two movements being known as inspiration and expiration. INSPIRATION is due to a muscular e?ort which enlarges the chest, so that the lungs have to expand in order to ?ll up the vacuum that would otherwise be left, the air entering these organs by the air passages. The increase of the chest in size from above downwards is mainly due to the diaphragm, the muscular ?bres of which contract and reduce its domed shape and cause it to descend, pushing down the abdominal organs beneath it. EXPIRATION is an elastic recoil, the diaphragm rising and the ribs sinking into the position that they naturally occupy, when muscular contraction is ?nished. Occasionally, forced expiration may occur, involving powerful muscles of the abdomen and thorax; this is typically seen in forcible coughing.

Nervous control Respiration is usually either an automatic or a REFLEX ACTION, each expiration sending up sensory impulses to the CENTRAL NERVOUS SYSTEM, from which impulses are sent down various other nerves to the muscles that produce inspiration. Several centres govern the rate and force of the breathing, although all are presided over by a chief respiratory centre in the medulla oblongata (see under BRAIN – Divisions). This in turn is controlled by the higher centres in the cerebral hemispheres, so that breathing can be voluntarily stopped or quickened.

Quantity of air The lungs do not completely empty themselves at each expiration and re?ll at each inspiration. With each breath, less than one-tenth of the total air in the lungs passes out and is replaced by the same quantity of fresh air, which mixes with the stale air in the lungs. This renewal, which in quiet breathing amounts to about 500 millilitres, is known as the tidal air. By a special inspiratory e?ort, an individual can draw in about 3,000 millilitres, this amount being known as complemental air. By a special expiratory e?ort, too, after an ordinary breath one can expel much more than the tidal air from the lungs – this extra amount being known as the supplemental or reserve air, and amounting to about 1,300 millilitres. If an individual takes as deep an inspiration as possible and then makes a forced expiration, the amount expired is known as the vital capacity, and amounts to around 4,000 millilitres in a healthy adult male of average size. Figures for women are about 25 per cent lower. The vital capacity varies with size, sex, age and ethnic origin.

Over and above the vital capacity, the lungs contain air which cannot be expelled; this is known as residual air, and amounts to another 1,500 millilitres.

Tests of respiratory e?ciency are used to assess lung function in health and disease. Pulmonary-function tests, as they are known, include spirometry (see SPIROMETER), PEAK FLOW METER (which measures the rate at which a person can expel air from the lungs, thus testing vital capacity and the extent of BRONCHOSPASM), and measurements of the concentration of oxygen and carbon dioxide in the blood. (See also LUNG VOLUMES.)

Abnormal forms of respiration Apart from mere changes in rate and force, respiration is modi?ed in several ways, either involuntarily or voluntarily. SNORING, or stertorous breathing, is due to a ?accid state of the soft palate causing it to vibrate as the air passes into the throat, or simply to sleeping with the mouth open, which has a similar e?ect. COUGH is a series of violent expirations, at each of which the larynx is suddenly opened after the pressure of air in the lungs has risen considerably; its object is to expel some irritating substance from the air passages. SNEEZING is a single sudden expiration, which di?ers from coughing in that the sudden rush of air is directed by the soft palate up into the nose in order to expel some source of irritation from this narrow passage. CHEYNE-STOKES BREATHING is a type of breathing found in persons suffering from stroke, heart disease, and some other conditions, in which death is impending; it consists in an alternate dying away and gradual strengthening of the inspirations. Other disorders of breathing are found in CROUP and in ASTHMA.... respiration

blockage of any of the passages by which air enters (and leaves) the lungs, which may be partial or complete. In partial obstruction, the patient can still move some air in and out of the lungs but often with difficulty. There may be a distinctive sound (see stridor) on inspiration through a partly obstructed airway. Complete obstruction will rapidly lead to respiratory and then cardiac arrest and requires prompt airway clearance and support.... airway obstruction

n. the alternation of active inhalation (or inspiration) of air into the lungs through the mouth or nose with the passive exhalation (or expiration) of the air. During inhalation the *diaphragm and *intercostal muscles contract, which enlarges the chest cavity and draws air into the lungs. Relaxation of these muscles forces air out of the lungs at exhalation. (See illustration.) Breathing is part of *respiration and is sometimes called external respiration. There are many types of breathing in which the rhythm, rate, or character is abnormal. See also apnoea; bronchospasm; Cheyne–Stokes respiration; dyspnoea; stridor.... breathing

Whooping-cough, or pertussis, is a respiratory-tract infection caused by Bordetella pertussis and spread by droplets. It may occur at all ages, but around 90 per cent of cases are children aged under ?ve. Most common during the winter months, it tends to occur in epidemics (see EPIDEMIC), with periods of increased prevalence occurring every three to four years. It is a noti?able disease (see NOTIFIABLE DISEASES). The routine vaccination of infants with TRIPLE VACCINE (see also VACCINE; IMMUNISATION), which includes the vaccine against whooping-cough, has drastically reduced the incidence of this potentially dangerous infection. In the 1990s over 90 per cent of children in England had been vaccinated against whooping-cough by their second birthday. In an epidemic of whooping-cough, which extended from the last quarter of 1977 to mid-1979, 102,500 cases of whooping-cough were noti?ed in the United Kingdom, with 36 deaths. This was the biggest outbreak since 1957 and its size was partly attributed to the fall in vaccination acceptance rates because of media reports suggesting that pertussis vaccination was potentially dangerous and ine?ective. In 2002, 105 cases were noti?ed in England.

Symptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.

Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough

(rale) n. a soft fine crackling sound heard in the lungs through the stethoscope. Crepitations are made either by air passages and alveoli (air sacs) opening up during inspiration or by air bubbling through fluid. They are not normally heard in healthy lungs.... crepitation

n. 1. (in anatomy) a thin musculomembranous dome-shaped muscle that separates the thoracic and abdominal cavities. The diaphragm is attached to the lower ribs at each side and to the breastbone and the backbone at the front and back. It bulges upwards against the heart and the lungs, arching over the stomach, liver, and spleen. There are openings in the diaphragm through which the oesophagus, blood vessels, and nerves pass. The diaphragm plays an important role in *breathing. It contracts with each inspiration, becoming flattened downwards and increasing the volume of the thoracic cavity. With each expiration it relaxes and is restored to its dome shape. 2. a hemispherical rubber cap fitted inside the vagina over the neck (cervix) of the uterus as a contraceptive. When combined with the use of a chemical spermicide the diaphragm provides reliable contraception with a failure rate as low as 2–10 pregnancies per 100 woman-years.... diaphragm

the normal physiological reflex to breathe out when the breath is held in inspiration and to breathe in when it is held in exhalation. [H. E. Hering (1866–1948), German physiologist; J. Breuer (1842–1925), German physician]... hering–breuer reflex

n. 1. (inspiration) the act of breathing air into the lungs through the mouth and nose. See breathing. 2. a gas, vapour, or aerosol breathed in for the treatment of conditions of the respiratory tract. —inhaler n.... inhalation

muscles that occupy the spaces between the ribs and are responsible for controlling some of the movements of the ribs. The superficial external intercostals lift the ribs during inspiration; the deep internal intercostals draw the ribs together during expiration.... intercostal muscles

n. one of four paired muscles of the neck (scalenus anterior, medius, minimus, and posterior), extending from the cervical (neck) vertebrae to the first and second ribs. They are responsible for raising the first and second ribs in inspiration and for bending the neck forward and to either side.... scalenus

a normal variation in the heart rate, which accelerates slightly on inspiration and slows on expiration. It is common in young fit individuals.... sinus arrhythmia