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  • Dyspnoea, or shortness of beath, refers to the feeling of ‘not getting enough air' or ‘air hunger'. Thi may herald cardiorespiratory disease, though may also occur in the context of many other acute and chronic conditions.


    • Causes of Acute Dyspnoea

    • Respiratory

    • Obstruction - asthma, COPD
    • Bronchiectasis - cystic fibrosis, ABPA
    • Vascular - pulmonary embolus, pulmonary hypertension
    • Interstitial lung disease
    • Pneumonia
    • Aspiration
    • Lung cancer
    • Pneumothorax
    • Pleural effusion
    • Anaphylaxis
    • Obesity hypoventilation syndrome
    • Cardiovascular

    • Heart failure
    • Pulmonary oedema
    • Myocardial ischaemia
    • Cardiomyopathy
    • Congenital heart disease
    • Valvular disease - aortic stenosis, aortic regurgitation
    • Tamponade
    • Other

    • Anaemia
    • Kyphoscoliosis
    • Metabolic acidosis
    • Late pregnancy
    • Neurologic - Guillain Barre, motor neuron disease
    • Muscular dystrophy
    • Anxiety
    • Causes of Chronic Dyspnoea

    • Other

    • Anaemia
    • Late pregnancy
    • Kyphoscoliosis
    • Muscular dystrophy
    • ALS

History of Presenting Complaint

    • Onset

      Whether the shortness of breath came on suddenly or gradually; during the day or at night; on exertion; or whether the patient  wakes up short of breath.
    • Sudden onsetSuggestive of severe cause e.g. PE, MI, pneumothorax, anaphylaxis, aspiration, APO, tamponade
    • Paroxysmal nocturnal dyspnoea - suddenly waking with shortness of breathSuggestive of heart failure
    • Onset after surgeryMay be due to PE, ACS or APO
    • Onset post traumaMay represent pneumothorax or rib fracture
    • Timing

    • How long the shortness of breath has been going on for, and whether it is intermittent or constant.
    • Associated Symptoms

      Whether the shortness of breath is associated with any other symptoms.
    • Central chest painSuggestive of pneumonia, pneumothorax, MI or PE
    • Pleuritic chest painSuggestive of pneumonia, pleural effusion or PE
    • PalpitationsMay suggest arrhythmia or anxiety
    • CoughSuggestive of pneumonia, COPD, interstitial fibrosis or bronchiectasis
    • HaemoptysisMay be due to PE, lung cancer or tuberculosis
    • FeversSuggestive of pneumonia
    • WheezeSuggestive of asthma, COPD or pulmonary oedema
    • Leg pain and swellingThink about DVT and risk of PE
    • Exacerbating Factors

      Whether the shortness of breath is worse on exertion, on lying flat, or after exposure to dust.
    • Exertional dyspnoeaMay represent heart failure, interstitial fibrosis or COPD
    • Orthopnoea - shortness of breath when lying flatCharacteristic of congestive cardiac failure
    • Alleviating Factors

      Whether the shortness of breath is relieved with rest, GTN, or with puffers.
    • Relief with bronchodilatorPotential exacerbation of asthma or COPD
    • Exercise Tolerance

    • How far / how many steps they can walk before short of breath, whether this has changed
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Ainslie G. Assessment of cough. Continuing Medical Education. 2009 Mar 19;27(2):68.
 Antoniou KM, Margaritopoulos GA, Tomassetti S, Bonella F, Costabel U, Poletti V. Interstitial lung disease. European Respiratory Review. 2014 Mar 1;23(131):40-54. Badran M, Ayas N, Laher I. Cardiovascular complications of sleep apnea: role of oxidative stress. Oxidative medicine and cellular longevity. 2014;2014. Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: is prevention possible?. The Lancet. 2015 Sep 12;386(9998):1075-85. Braman SS, Davis SM. Wheezing in the elderly. Asthma and other causes. Clinics in geriatric medicine. 1986 May;2(2):269-83. Cano-Jiménez E, Hernández González F, Peloche G. Comorbidities and Complications in Idiopathic Pulmonary Fibrosis. Medical Sciences. 2018 Sep;6(3):71. Committee on Rating of Mental and Physical Impairment. The Respiratory System. JAMA. 1965 Nov; 194(8): 919-932. Cushman M. Epidemiology and risk factors for venous thrombosis. InSeminars in hematology 2007 Apr 1 (Vol. 44, No. 2, pp. 62-69). WB Saunders. del Giudice MM, Allegorico A, Parisi G, Galdo F, Alterio E, Coronella A, Campana G, Indolfi C, Valenti N, Di Prisco S, Caggiano S. Risk factors for asthma. InItalian journal of pediatrics 2014 Dec (Vol. 40, No. 1, p. A77). BioMed Central. Feierabend R. Hoarseness in adults. Am Fam Physician. 2009;80:363. Gordon BR. Asthma History and Presentation. Otolaryngeal Clin N Am. 2008; 41: 375-385. Harding SM. Complications and consequences of obstructive sleep apnea. Current opinion in pulmonary medicine. 2000 Nov 1;6(6):485-9. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Archives of internal medicine. 2000 Mar 27;160(6):809-15. Ho WK. Deep vein thrombosis: risks and diagnosis. Australian family physician. 2010 Jul;39(7):468. Holzinger F, Beck S, Dini L, Stöter C, Heintze C. The diagnosis and treatment of acute cough in adults. Deutsches Ärzteblatt international. 2014;111:356. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:1S-23S. Kilgore D, Najm W. Common Respiratory Diseases. Prim Care Clin Office Pract. 2010; 37: 297-324. Krieger BP. When wheezing may not mean asthma: other common and uncommon causes to consider. Postgraduate medicine. 2002 Aug 1;112(2):101-11. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. The Lancet. 2007 Sep 1;370(9589):765-73. Mathews KP. Respiratory Atopic Disease. JAMA. 1982 Nov; 248(20): 2587-2610. Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA. Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. InMayo Clinic Proceedings 2008 May 1 (Vol. 83, No. 5, pp. 584-594). Elsevier. O'Donnell AE. Bronchiectasis. Chest. 2008 Oct 1;134(4):815-23. Osann KE. Lung Cancer in Women: The Importance of Smoking, Family History of Cancer, and Medical History of Respiratory Disease. Cancer Research. 1991 Sep; 51: 4893-4897. Papiris S, Kotanidou A, Malagari K, Roussos C. Clinical review: severe asthma. Critical Care. 2001 Feb;6(1):30. Prakash UBS. Uncommon Causes of Cough. Chest. 2006;129:206S. Pratter MR. Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. CHEST Journal. 2006 Jan 1;129(1_suppl):59S-62S. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Archives of internal medicine. 2000 Dec 11;160(22):3415-20. Sethi GR, Batra V. Bronchiectasis: causes and management. The Indian Journal of Pediatrics. 2000 Feb 1;67(2):133-9. Travis, W.D., Costabel, U., Hansell, D.M., King Jr, T.E., Lynch, D.A., Nicholson, A.G., Ryerson, C.J., Ryu, J.H., Selman, M., Wells, A.U. and Behr, J., 2013. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. American journal of respiratory and critical care medicine, 188(6), pp.733-748. Troy L, Corte T. Interstitial lung disease in 2015: where are we now?. Australian family physician. 2015 Aug;44(8):546. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. Jama. 2004 Apr 28;291(16):2013-6.