From the Guidelines
Tachypnea, or rapid breathing, occurring suddenly requires immediate medical attention as it can indicate serious underlying conditions, such as pulmonary embolism, pneumonia, or heart failure, and should be evaluated and managed according to the most recent guidelines, including the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Causes and Evaluation
The causes of sudden tachypnea can be diverse, including pulmonary embolism, pneumonia, asthma exacerbation, heart failure, anxiety attacks, or COVID-19. Evaluation should focus on signs of increased work of breathing, oxyhemoglobin saturation, and potential reversible causes of the tachycardia or tachypnea.
- Common symptoms of pulmonary embolism, a potentially fatal disorder, include dyspnea, chest pain, or syncope, either singly or in combination, as discussed in the European Society of Cardiology guidelines on diagnosis and management of acute pulmonary embolism 1.
- The clinical presentation of pulmonary embolism can range from haemodynamic instability to silent, and evaluating the likelihood of PE in an individual patient according to the clinical presentation is crucial.
Management
Management of tachypnea should prioritize determining the underlying cause and addressing it promptly.
- Initial steps should include providing supplementary oxygen if oxygenation is inadequate, attaching a monitor to the patient, evaluating blood pressure, and establishing IV access, as outlined in the ACLS Tachycardia With Pulse Algorithm 1.
- Treatment may include bronchodilators like albuterol, antibiotics for infections, anticoagulants for blood clots, or diuretics like furosemide for heart failure, depending on the underlying cause.
- It is essential to assess the patient’s degree of instability and determine if the instability is related to the tachycardia or tachypnea, and proceed with immediate intervention if necessary, such as cardioversion or other treatments aimed at stabilizing the patient.
From the Research
Definition and Identification of Tachypnea
- Tachypnea is one of the first signs of patient deterioration and accurate measurement of respiratory rate is a fundamental part of assessment 2.
- It is essential to ensure patient observations lead to prompt identification of tachypnea.
Relationship with Chronic Obstructive Pulmonary Disease (COPD)
- COPD is a major cause of morbidity, mortality, and health-care use worldwide, and tachypnea can be a symptom of COPD 3.
- The diagnosis of COPD should be suspected in patients with risk factors, such as a history of smoking, who report dyspnea at rest or with exertion, chronic cough with or without sputum production, or a history of wheezing 4.
- Tachypnea can be a sign of disease severity in patients with COPD, and cardiac diseases can contribute to the overall morbidity and mortality of patients with COPD 5.
Management and Treatment
- Pharmacotherapy and smoking cessation are the mainstays of treatment for COPD, and pulmonary rehabilitation, long-term oxygen therapy, and surgery may be considered in select patients 4.
- The therapeutic management of patients with cardiac and pulmonary comorbidities, such as COPD, may be challenging, and bronchodilators may have cardiac side effects 5.
- Current guidelines recommend starting monotherapy with an inhaled bronchodilator, stepping up to combination therapy as needed, and/or adding inhaled corticosteroids as symptom severity and airflow obstruction progress 4.