Ma I, Lucey CR. Ma I, Lucey C.R. Ma, Iris, and Catherine R. Lucey.Chapter 25. Dyspnea. In: Henderson MC, Tierney LM, Jr., Smetana GW. Henderson M.C., Tierney L.M., Jr., Smetana G.W. Eds. Mark C. Henderson, et al.eds. The Patient History: An Evidence-Based Approach to Differential Diagnosis New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=500&sectionid=41026571. Accessed April 19, 2019.
Ma I, Lucey CR. Ma I, Lucey C.R. Ma, Iris, and Catherine R. Lucey.. "Chapter 25. Dyspnea." The Patient History: An Evidence-Based Approach to Differential Diagnosis Henderson MC, Tierney LM, Jr., Smetana GW. Henderson M.C., Tierney L.M., Jr., Smetana G.W. Eds. Mark C. Henderson, et al. New York, NY: McGraw-Hill, 2012, http://accessmedicine.mhmedical.com/content.aspx?bookid=500&sectionid=41026571.
A 67-year-old man comes to your clinic for his annual appointment concerned about increasing shortness of breath. A year ago he was able to walk up the stairs to his apartment without difficulty, but now he has difficulty walking one block. He has a 70 pack-year smoking history, and several previous attempts to stop smoking have been unsuccessful.
Does the patient require urgent intervention?
Is the shortness of breath acute or chronic?
What additional questions would you ask to learn more about his shortness of breath?
What is the organ system involved in the patient's shortness of breath (cardiac, pulmonary, hematologic, or psychiatric)?
Cardiomyopathies Conditions that damage heart muscle and may cause heart failure. Etiologies are diverse. Common causes include ischemic heart disease, valvular disease, hypertension, infections, toxins, and genetic disorders.
Dyspnea Abnormally increased awareness of breathing or sensation of difficulty breathing.
Interstitial lung disease A heterogeneous set of conditions characterized by hypoxia and interstitial (pulmonary vessels, bronchi, connective tissue) abnormalities on chest radiographs. Examples include sarcoidosis, idiopathic pulmonary fibrosis, rheumatoid lung, and pneumoconioses.
Orthopnea Dyspnea when lying flat. Typically described in terms of the number of pillows the patient uses to breathe comfortably to sleep.
Paroxysmal nocturnal dyspnea (PND) Dyspnea that wakes the patient from sleep. The patient may report waking up gasping for air, and classically finds relief by sitting by an open window.
Platypnea Dyspnea that improves when the patient lies down.
Trepopnea Dyspnea that occurs in the lateral decubitus position on one side, but not the other.
The purpose of breathing is to meet the metabolic demands of the body. Thus, any condition that increases the work of breathing (eg, airway obstruction, changes in lung compliance, or respiratory muscle weakness) or increases respiratory drive (eg, hypoxia or acidosis) may result in dyspnea.2 In addition, dyspnea may result from or be exacerbated by primary psychological conditions (eg, anxiety disorders).
The differential diagnosis of dyspnea depends on the duration of the symptom and the clinical setting. Conditions associated with acute dyspnea (developing over hours to a few days) are outlined under alarm conditions.