Reason to Breathe is the first book in the million-copy bestselling Breathing Series. “No one tried to get involved with me, and I kept to myself. This was the place. Reason to Breathe is first novel in the new adult trilogy The Breathing Series by USA Today bestselling author Rebecca Donovan. Editorial Reviews. Review. "When hope is a fragile thread, love is a miracle." — Tammara Webber, New York Times bestselling author of Easy. "Emotionally.

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Dyspnea on exertion DOE may occur normally, but is considered indicative of disease when it occurs at a level of activity that is usually well tolerated. Dyspnea should be differentiated from tachypnea, hyperventilation, and hyperpnea, which refer to respiratory variations regardless of the patients" subjective sensations.

Tachypnea is an increase in the respiratory rate above normal; hyperventilation is increased minute ventilation relative to metabolic need, and hyperpnea is a disproportionate rise in minute ventilation relative to an increase in metabolic level.

These conditions may not always be associated with dyspnea. Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing. Paroxysmal nocturnal dyspnea PND is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. Two uncommon types of breathlessness are trepopnea and platypnea.

Trepopnea is dyspnea that occurs in one lateral decubitus position as opposed to the other.


Platypnea refers to breathlessness that occurs in the upright position and is relieved with recumbency. Technique A patient with dyspnea may say: "I feel short of breath," "I"m having difficulty breathing," "I can"t catch my breath," "I feel like I"m suffocating.

Begin with a nonleading question: Do you have any difficulty breathing? If the response is affirmative and dyspnea is established as a problem, it should be characterized in detail.

When did it begin? Has the onset been sudden or insidious? Inquire about the frequency and duration of attacks.

Reason to Breathe: The Breathing Series Summary & Study Guide

The conditions in which dyspnea occurs should be ascertained. Response to activity, emotional state, and change of body position should be noted. Ask about associated symptoms: chest pain, palpitations, wheezing, or coughing. Sometimes a nonproductive cough may be present as a "dyspnea equivalent.

How much has he smoked?

Dyspnea on exertion is by no means always indicative of disease. Normal persons may feel dyspneic with strenuous exercise. The level of activity tolerated by any individual depends on such variables as age, sex, body weight, physical conditioning, attitude, and emotional motivation. Dyspnea on exertion would be abnormal if it occurred with activity that is normally well tolerated by the patient. It is helpful to ask if he has noticed any recent or progressive limitation in his ability to conduct specific tasks that he was able to perform without difficulty in the past e.

The degree of functional impairment can be assessed in this manner.

Additional questions should be aimed at ascertaining whether the patient has orthopnea or paroxysmal nocturnal dyspnea. Inquire about the number of pillows he uses under his head at night and whether he has ever had to sleep sitting up.

Reason to Breathe

Does he develop coughing or wheezing in the recumbent position? Did he ever wake up at night with shortness of breath? How long after lying down did the episode occur, and what did he do to relieve his distress? Characteristically, the patient with left ventricular failure sits up at bedside, dangles his feet, and refrains from ambulation or other activity that is likely to worsen his symptoms.

(PDF Download) Reason To Breathe (The Breathing Series Book 1) Read Online

Basic Science Spontaneous respiration is controlled by neural and chemical mechanisms. At rest, an average 70 kg person breathes 12 to 15 times a minute with a tidal volume of about ml. A normal individual is not aware of his or her respiratory effort until ventilation is doubled, and dyspnea is not experienced until ventilation is tripled. An abnormally increased muscular effort is now needed for the process of inspiration and expiration. Because dyspnea is a subjective experience, it does not always correlate with the degree of physiologic alteration.

Some patients may complain of severe breathlessness with relatively minor physiologic change; others may deny breathlessness even with marked cardio-pulmonary deterioration. There is no universal theory that explains the mechanism of dyspnea in all clinical situations.

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Campbell and Howell have formulated the "length—tension inappropriateness theory," which states that the basic defect in dyspnea is a mismatch between the pressure tension generated by respiratory muscles and the tidal volume change of length that results. Whenever such disparity occurs, the muscle spindles of the intercostal muscles transmit signals that bring the act of breathing to the conscious level.

Additionally, juxtacapillary receptors J-receptors , located in the alveolar interstitium and supplied by unmyelinated fibers of the vagus nerve, are stimulated by pulmonary congestion. This activates the Hering—Breuer reflex whereby inspiratory effort is terminated before full inspiration is achieved, resulting in rapid and shallow breathing.


The J-receptors may be responsible for dyspnea in situations where pulmonary congestion occurs, such as with pulmonary edema. Other theories that have been proposed to explain dyspnea include acid-base imbalance, central nervous system mechanisms, decreased breathing reserve, increased work of breathing, increased transpulmonary pressure, fatigue of respiratory muscles, increased oxygen cost of breathing, dyssynergy of intercostal muscles and the diaphragm, and abnormal respiratory drive.

Orthopnea is caused by pulmonary congestion during recumbency. In the horizontal position there is redistribution of blood volume from the lower extremities and splanchnic beds to the lungs.

In normal individuals this has little effect, but in patients in whom the additional volume cannot be pumped out by the left ventricle because of disease, there is a significant reduction in vital capacity and pulmonary compliance with resultant shortness of breath.

Additionally, in patients with congestive heart failure the pulmonary circulation may already be overloaded, and there may be reabsorption of edema fluid from previously dependent parts of the body. Pulmonary congestion decreases when the patient assumes a more erect position, and this is accompanied by an improvement in symptoms. Paroxysmal nocturnal dyspnea may be caused by mechanisms similar to those for orthopnea. I pretty much skimmed ALL the parts whenever Emma uses Cole as her distraction or as her anesthetic, and by that, I meant them having sex.

Honestly, Evan is the only reason why I continued reading this book. I was very curious about what happened to him after Emma left. I also think his 2 week deal with Emma was really stupid. He had someone who loved and cared for him even if he was at his lowest.

What else? Let me type some things I liked instead: Sara — I love her character. She kept on taking care of Emma even when she was in France.

Emma is so lucky to have Sara as a best friend. Emma and Evan took their time before getting back together — thank God!


I liked that they tried to get to know each other again and started communicating about their feelings before committing in a relationship. I heard Ms. Donovan is writing a novel about Jonathan the guy Emma left with at the end of Barely Breathing.The ending. Their story begins when he contradicts her in the classroom, and for some reason, this gets Emma SO angry. For more reviews got to http: Hate is just wrong. She doesn't deserve to take care of her own children after the shit she does to other's children..

There was moments I wanted to throw my site away, smiled, cried and I am lost for words. The book left with such a cliff hanger, so glad the second one is out- because I need to find out what happens!

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