Sensation of incomplete lung emptying

Specialty: Respiratory.

• functional expiratory dyspnea
• sensation of lung air retention

Why it occurs

• Dynamic air trapping secondary to severe pulmonary emphysema (the loss of lung elasticity and the collapse of the small airway during expiration prevent the patient from completely emptying their lungs, maintaining a high residual volume)
• Bronchial asthma with fixed obstruction or remodeling of the airway (chronic inflammation that causes persistent limitation of air outflow)
• Chronic hyperventilation syndrome with dysfunctional respiratory pattern (the patient takes rapid, shallow breaths over a high inspiratory reserve volume, constantly feeling that "he cannot exhale all the air")
• Obstruction of the central airway by a mass or tumor with a valvular effect (it allows air to enter during inspiration but collapses during expiration).

Initial workup

Pre- and post-bronchodilator forced spirometry; Whole body plethysmography (essential to quantify residual volume - VR, total lung capacity - TLC and VR/CPT ratio confirming air trapping); High-resolution chest x-ray and CT to evaluate the extent of emphysema; Analytical arterial blood gas.

Standard management

• Tiotropium — long-acting muscarinic antagonist, 18 micrograms inhaled once daily to optimize alveolar emptying and reduce dyspnea
• Formoterol — long-acting beta-2 agonist, 12 micrograms inhaled every 12 hours
• Prolonged-release theophylline (100-200 mg orally every 12 hours, prescribed exceptionally, monitoring plasma levels if inhalers are insufficient).