Summary
Dyspnoea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort.
Activation of several pathways can lead to the sensation of breathlessness. Increased work in breathing, stimulation of the receptors of the upper or lower airway, lung parenchyma, or chest wall, and excessive stimulation of the respiratory centre by central and peripheral chemoreceptors can all lead to this sensation. These stimuli are transferred to the central nervous system via respiratory muscle and vagal afferents and are then processed in the context of the affective state, attention, and prior experience of the patient, resulting in dyspnoea. [1] [2]
The evaluation and management of dyspnoea is directed by the clinical presentation, findings from the history and physical examination, and preliminary investigation results.
The aetiology of dyspnoea covers a broad range of pathologies from mild, self-limiting processes to life-threatening conditions. Diseases of the cardiovascular, pulmonary, and neuromuscular systems are the most common aetiologies.
Differential diagnosis
- Common
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- COPD
- Pulmonary tumours
- Infective pneumonitis (bacterial, viral, fungal, tuberculous)
- Non-infective pneumonitis (eosinophilic, radiation, aspiration, hypersensitivity pneumonitis)
- Bronchiectasis
- Interstitial lung disease
- Sarcoidosis
- Asthma
- Bronchitis
- Laryngitis
- Epiglottitis
- Obstructive sleep apnoea
- Pulmonary embolism (thrombotic, air, amniotic fluid, tumour)
- Pleural effusion and pleural tumours
- Acute coronary syndrome and angina
- Congestive heart failure
- Methaemoglobinaemia and carbon monoxide poisoning
- Anaemia
- Methaemoglobinaemia and carbon monoxide poisoning
- Thrombotic thrombocytopenic purpura
- Gastro-oesophageal reflux disease
- Ascites
- Stroke
- Shock
- Thyroid disease
- Anxiety and panic attacks
- Normal ageing, deconditioning, and obesity
- Uncommon
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- Pulmonary contusion
- Angio-oedema
- Foreign body aspiration
- Tracheobronchial tumours (benign or malignant)
- Retrosternal goitre
- Vocal cord dysfunction
- Pulmonary hypertension
- Hepatopulmonary syndrome
- Pulmonary arteriovenous malformations
- Mesothelioma
- Pneumothorax and pneumomediastinum
- Pleuritis
- Haemothorax
- Arrhythmias
- Acquired valvular heart disease
- Congenital heart disease
- Cardiac drugs
- Myocardial disease (cardiomyopathy, myocarditis)
- Pericardial disease
- Aortic dissection
- Superior vena cava syndrome
- Pulmonary leukostasis
- Tetanus
- Botulism
- Amyotrophic lateral sclerosis
- Polio and other acute viral anterior horn infections
- Guillain-Barre syndrome
- Myasthenia gravis
- Respiratory muscle deficiency
- Paraneoplastic myasthenic syndrome
- Anaphylaxis
- Cushing's syndrome
- Phaeochromocytoma
- Kyphoscoliosis and pectus excavatum
- Diphtheria
