PND is acute, severe, brcathlessness that wakes the patient from steep. The patient has to sit upright gasping in bed or sitting on the edge of the bed. The patient may even get out of bed, occasionally throwing open the windows in an attempt to relieve the distress. The intensity of the symptom is often described as akin to suffocation. Characteristically, the patient has a cough producing frothy sputum which may be streaked with blood. The mechanism is explained in Figure 3.2, which also lists the causes. Paroxysmal nocturnal dyspnoea has to be distinguished from nocturnal asthma (Ch. 4, p. ¡39).
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.