Dyspnoea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort. It is a common symptom, present in up to half of patients admitted to acute, tertiary care hospitals and in one quarter of medical outpatients. Dyspnoea accounts for approximately 3.4 million accident and emergency department visits in the US annually.
There are also multiple sensations of dyspnoea; the best described can be grouped together into:
Sensation of work or effort
Air hunger/unsatisfied inspiration.
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. Dyspnoea may be acute (e.g., acute exacerbation of congestive heart failure, acute pulmonary embolism, acute heart valve insufficiency), subacute (e.g., worsening asthma, exacerbation of chronic obstructive pulmonary disease [COPD]) or chronic (e.g., stable COPD, stable interstitial lung disease).
The evaluation and management of dyspnoea is directed by the clinical presentation, findings from the history and physical examination, and preliminary investigation results.
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Pneumonia (bacterial, viral, fungal, tuberculous)
- Coronavirus disease 2019 (COVID-19)
- Acute coronary syndrome (ACS)
- Stable angina
- Interstitial lung disease
- Non-infective pneumonitis (eosinophilic, radiation, aspiration, hypersensitivity pneumonitis)
- Acute bronchitis
- Pulmonary embolism (thrombotic, air, amniotic fluid, tumour)
- Pleural effusion
- Gastro-oesophageal reflux disease (GERD)
- Pulmonary tumours
- Anxiety and panic attacks
- Normal ageing, deconditioning, and obesity
- Aortic dissection
- Pulmonary contusion
- Foreign body aspiration
- Tracheobronchial tumours (benign or malignant)
- Retrosternal goitre
- Vocal cord dysfunction
- Pulmonary hypertension
- Hepatopulmonary syndrome
- Pulmonary arteriovenous malformations
- Pulmonary veno-occlusive disease
- Pneumothorax and pneumomediastinum
- Acquired valvular heart disease
- Congenital heart disease
- Cardiac drugs
- Myocardial disease (cardiomyopathy, myocarditis)
- Pericardial disease
- Superior vena cava syndrome
- Methaemoglobinaemia and carbon monoxide poisoning
- Phrenic nerve paralysis
- Amyotrophic lateral sclerosis
- Polio and other acute viral anterior horn infections
- Guillain-Barre syndrome
- Myasthenia gravis
- Respiratory muscle deficiency
- Paraneoplastic myasthenic syndrome
- Thyroid disease
- Cushing syndrome
- Kyphoscoliosis and pectus excavatum
Tomasz J. Kuzniar, MD, PhD
Clinical Assistant Professor of Medicine
University of Chicago
Division of Pulmonary and Critical Care Medicine
NorthShore University HealthSystem
TJK is chair of the Education Committee of the American Academy of Sleep Medicine (AASM) and oversees the development of several educational products for the AASM. TJK is co-author of, and receives royalties from, two topics on sleep apnoea for UpToDate.
Dr Tomasz J. Kuzniar would like to gratefully acknowledge Dr Kamilla Kasibowska-Kuzniar and Dr Kaiser G. Lim, previous contributors to this monograph.
KK-K and KGL declare that they have no competing interests.
Nicholas Maskell, MD
Senior Lecturer and Consultant Physician
North Bristol Lung Centre
NM declares that he has no competing interests.
Najib Rahman, BM, BCh, MA (Oxon), MRCP (UK)
MRC Training Fellow and Specialist Registrar, Respiratory Medicine
Oxford Centre for Respiratory Medicine
NR declares that he has no competing interests.
Jonathan P. Parsons, MD
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
Ohio State University Medical Center
JPP declares that he has no competing interests.
- AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
- ACR appropriateness criteria: suspected pulmonary hypertension
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