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Approach to the patient with dyspnea

Richard M Schwartzstein, MD
Section Editor
Talmadge E King, Jr, MD
Deputy Editor
Helen Hollingsworth, MD


Dyspnea, or breathing discomfort, is a common symptom that afflicts millions of patients with pulmonary disease and may be the primary manifestation of lung disease, myocardial ischemia or dysfunction, anemia, obesity, or deconditioning. Examination of the language of dyspnea suggests that this symptom represents a number of qualitatively distinct sensations, and that the words utilized by patients to describe their breathing discomfort may provide insight into the underlying pathophysiology of the disease.

The key elements in the evaluation of the patient with dyspnea will be reviewed here. The basic physiology of dyspnea, the evaluation of acute dyspnea, and dyspnea in pregnancy are discussed separately. (See "Physiology of dyspnea" and "Evaluation of the adult with dyspnea in the emergency department" and "Maternal adaptations to pregnancy: Physiologic respiratory changes and dyspnea".)


A consensus statement of the American Thoracic Society defines dyspnea in the following way [1]:

"Dyspnea is a term used to characterize a subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioral responses."

Dyspnea is considered acute when it develops over hours to days and chronic when it has been for more than four to eight weeks. Some patients present with acute worsening of chronic breathlessness that may be caused by a new problem or a worsening of the underlying disease (eg, asthma, chronic obstructive pulmonary disease, heart failure).

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Literature review current through: Nov 2017. | This topic last updated: Feb 16, 2017.
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