Essoufflement chez l'adulte: Fiche pratique de l’IPCRG à l'intention des médecins de soins primaires
DOI :
https://doi.org/10.62438/tunismed.v104i06.6803Mots-clés :
Autogestion, Dyspnée Chronique, Modèle Biopsychosocial, Multimorbidité, Rééducation Respiratoire, Stratégie Diagnostique Structurée, Tolérance à l’Effort, Troubles AnxieuxRésumé
Contexte: L’essoufflement est fréquent, anxiogène et souvent difficile à préciser en soins primaires. Lorsqu’il persiste au-delà de quatre semaines, il altère
fortement la qualité de vie, la capacité fonctionnelle et le pronostic, et peut conduire à des consultations en urgence si les causes sous-jacentes ne sont pas
identifiées et prises en charge. L’essoufflement chronique est généralement multifactoriel, associant causes cardio-respiratoires et facteurs contributifs tels
que l’obésité, le déconditionnement, les troubles du schéma respiratoire, l’anxiété, l’anémie ou l’affection post- coronavirus 2019.
Objectif: Cette fiche technique propose aux médecins de soins primaires une démarche structurée, pragmatique et centrée sur la personne pour l’évaluation et la prise en charge de l’essoufflement chronique.
Contenu: La fiche technique insiste sur le repérage précoce des tableaux aigus/urgents de l’essoufflement chez les adultes (dont l’oxymétrie de pouls si
disponible), l’exploration systématique (anamnèse, examen, examens accessibles: spirométrie, radiographie thoracique, électrocardiogramme, numération formule sanguine, peptide natriurétique de type B N-terminal, bilans biologiques ciblés, dépistage de l’anxiété/ de la dépression et évaluation du niveau d’activité physique), et une démarche diagnostique progressive nécessitant parfois plusieurs consultations, tout en sécurisant le suivi. La prise en charge de l’essoufflement combine l’optimisation du traitement des maladies sous-jacentes et l’introduction précoce de stratégies non pharmacologiques fondées sur des preuves. Le modèle «Respirer-Penser-Fonctionner» structure le contrôle symptomatique: Correction des schémas respiratoires inadaptés, réduction de la détresse, et lutte contre le déconditionnement via réadaptation fonctionnelle et reprise d’activité.
Conclusion: Une approche structurée, associée à la mise en œuvre précoce d’interventions non pharmacologiques, pourrait améliorer le suivi en consultation, favoriser l’autogestion et optimiser la qualité de vie.
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Références
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