Shortness of Breath*

  1. In a patient with a new presentation of shortness of breath take a sufficient history to avoid inappropriately or prematurely limiting the diagnosis to respiratory and cardiac causes (i.e., consider causes such as hematologic, environmental, psychogenic, deconditioning, gastrointestinal).
  2. Regardless of where you assess the patient who presents with shortness of breath (e.g., office, home visit) consider life-threatening conditions (e.g., pulmonary embolus, foreign body aspiration in a child, anaphylaxis, myocardial infarction).
  3. When a patient with a diagnosed cause of dyspnea presents with worsening symptoms or treatment failure:
    • Ask about other factors that might have exacerbated their symptoms (e.g., new pets, environmental factors, medication technique/adherence, dietary changes)
    • Re-evaluate your primary diagnosis (i.e., the original diagnosis may have been incorrect)
    • Consider co-existing diagnoses (e.g., a patient with asthma who has pneumonia)
  4. In an anxious patient with shortness of breath don’t assume anxiety is the cause of their symptoms.