Shortness of breath ,is often
described as an intense
tightening in the chest, air
hunger, difficulty breathing,
breathlessness or a feeling of
1. Distinguish acute from chronic dyspnea which acute occurring over
hours to days and chronic occurring for more than 4 to 8 weeks.
2. Patients with chronic dyspnea usually have either heart or lung disease
or both. It may be difficult to distinguish between the two.
Depending on patient presentation, any of the following tests
may be helpful in distinguishing between lung and heart
• Sputum Gram stain and culture (if patient has sputum)
• ECG, echocardiogram
3. The most common causes of acute dyspnea include CHF exacerbation,
pneumonia, bronchospasm, PE, and anxiety.
4. Assess the patient’s baseline level of activity, whether the dyspnea is
new in onset, and its association with exertion.
5. If the patient has a history of smoking, cough, sputum, repeated
infections, or occupational exposure, lung disease is likely to be the
reason for chronic dyspnea.
6. Dyspnea is a symptom of the disease, rather than a disease itself.
1.Thorough history and physical examination,
2. Pulse oximetry—normal is 96% to 100% on
room air. Be aware that the baseline oxygen
saturation of many COPD patients is
3. ABG—may be indicated if oxygen
saturation is low on pulse oximetry, if
hypercarbia is suspected, or to
evaluate for acid–base abnormalities.
4. CXR—can reveal pneumothorax, pleural effusion, pulmonary
vascular congestion secondary to CHF, infiltrates due to pneumonia,
ILD, and so on.
5. CBC—to evaluate for anemia, infection.
6. ECG—may show ventricular hypertrophy or evidence of ischemic
7. Echocardiogram—for further evaluation of CHF, Valvular heart disease.
8. PFTs—perform if all of the above are normal or if obstructive lung
disease is suspected.
9. V/Q scan or spiral CT scan—perform if PE is suspected.
10. Bronchoscopy—indicated if foreign body aspiration is suspected.
1. Treat the underlying cause.
2. Use intubation and mechanical ventilation in the following situations:
a. If impending respiratory failure is suspected
b. If patient is unable to protect airway (e.g., decreased mental status,
stroke, drug overdose)
c. Severe hypoxia despite supplemental oxygen (PO2 50)
3. Exercise and conditioning may improve perception of dyspnea.