Evaluation of dyspnea

Dyspnea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort. There are multiple sensations of dyspnea; the best described can be grouped together into:[1]Parshall MB, Schwartzstein RM, Adams L, et al. American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012 Feb 15;185(4):435-52. http://www.atsjournals.org/doi/full/10.1164/rccm.201111-2042ST http://www.ncbi.nlm.nih.gov/pubmed/22336677?tool=bestpractice.com ​

• Sensation of work or effort

• Tightness

• Air hunger/unsatisfied inspiration.

Dyspnea is a common symptom, present in up to half of patients admitted to acute, tertiary care hospitals and in one quarter of medical outpatients.[1]Parshall MB, Schwartzstein RM, Adams L, et al. American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012 Feb 15;185(4):435-52. http://www.atsjournals.org/doi/full/10.1164/rccm.201111-2042ST http://www.ncbi.nlm.nih.gov/pubmed/22336677?tool=bestpractice.com In 2021, dyspnea accounted for 5.92 million emergency department visits in the US.[2]Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2021 emergency department summary tables. Oct 2023 [internet publication]. https://www.cdc.gov/nchs/ahcd/web_tables.htm In 2020, the comparable figure was lower (4.86 million); COVID-19 may have contributed to reduced demand for hospital-based emergency services during 2020.[3]Melnick G, O'Leary JF, Zaniello BA, et al. COVID-19 driven decline in emergency visits: has it continued, is it permanent, and what does it mean for emergency physicians? Am J Emerg Med. 2022 Nov;61:64-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387065 http://www.ncbi.nlm.nih.gov/pubmed/36057210?tool=bestpractice.com [4]Pines JM, Zocchi MS, Black BS, et al. Characterizing pediatric emergency department visits during the COVID-19 pandemic. Am J Emerg Med. 2021 Mar;41:201-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682424 http://www.ncbi.nlm.nih.gov/pubmed/33257144?tool=bestpractice.com ​​​​

The etiology of dyspnea covers a broad range of pathologies from mild, self-limited processes to life-threatening conditions. Diseases of the cardiovascular, pulmonary, and neuromuscular systems are the most common. Dyspnea 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 dyspnea is directed by the clinical presentation, findings from the history and physical exam, and preliminary investigation results.[5]Berliner D, Schneider N, Welte T, et al. The differential diagnosis of dyspnea. Dtsch Arztebl Int. 2016 Dec 9;113(49):834-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247680 http://www.ncbi.nlm.nih.gov/pubmed/28098068?tool=bestpractice.com