From the Guidelines
When a patient presents with shortness of breath, it is crucial to ask a comprehensive set of questions to determine the cause and severity, focusing on the onset, duration, and progression of symptoms, as well as associated symptoms and medical history, to guide appropriate diagnostic testing and management. Begin by asking about the onset, duration, and progression of symptoms: when did the shortness of breath start, is it constant or intermittent, and has it worsened over time? Inquire about aggravating and alleviating factors, such as whether it occurs at rest, with exertion, when lying flat, or if anything makes it better or worse. Ask about associated symptoms including chest pain, cough, wheezing, fever, leg swelling, palpitations, dizziness, or syncope. Obtain a detailed medical history focusing on cardiac conditions (heart failure, coronary artery disease), pulmonary diseases (asthma, COPD, pulmonary embolism), and other relevant conditions like anemia or thyroid disorders, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1.
Some key questions to ask include:
- When did the shortness of breath start?
- Is it constant or intermittent?
- Has it worsened over time?
- Are there any aggravating or alleviating factors?
- Are there any associated symptoms, such as chest pain or cough?
- What is the patient's medical history, including cardiac and pulmonary conditions?
- What medications is the patient currently taking, and have there been any recent changes?
- Are there any environmental exposures or recent travel that could be contributing to the symptoms?
It is also essential to assess for red flag symptoms, such as severe chest pain, hemoptysis, severe fatigue, or inability to speak in full sentences, which may indicate a medical emergency requiring immediate intervention, as noted in the American Thoracic Society statement on the mechanisms, assessment, and management of dyspnea 1. Additionally, consider the patient's quality of life and daily activities, as chronic breathlessness can substantially limit these, and symptomatic management may be necessary, as discussed in the European Association for Palliative Care task force expert position statement on palliative care for people living with heart failure 1.
By taking a systematic approach to questioning and assessment, healthcare providers can differentiate between cardiac, pulmonary, psychological, and other causes of dyspnea, guiding appropriate diagnostic testing and management to improve patient outcomes and quality of life.
From the Research
Questions to Ask if a Patient Presents with Shortness of Breath
When a patient presents with shortness of breath, it is essential to ask a series of questions to determine the underlying cause and provide appropriate treatment. Some of these questions include:
- What is the patient's medical history, including any pre-existing respiratory or cardiac conditions? 2
- Has the patient experienced any recent trauma or injury that could be contributing to their shortness of breath?
- What is the patient's current oxygen saturation level, and are they receiving oxygen therapy? 3, 4
- Has the patient undergone any recent diagnostic tests, such as pulmonary function tests, to determine the cause of their shortness of breath? 2
- Is the patient experiencing any other symptoms, such as chest pain or coughing, that could be related to their shortness of breath?
Assessment and Treatment Approach
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is a widely accepted method for assessing and treating patients with shortness of breath. This approach involves:
- Assessing the patient's airway to ensure it is patent and protected 5
- Evaluating the patient's breathing pattern and oxygen saturation level 3, 4
- Assessing the patient's circulation, including their blood pressure and heart rate 5
- Evaluating the patient's disability, including their level of consciousness and ability to respond to commands 5
- Exposing the patient to ensure that there are no other underlying conditions that could be contributing to their shortness of breath 5
Oxygen Therapy Considerations
When considering oxygen therapy for a patient with shortness of breath, it is essential to:
- Monitor the patient's peripheral oxygen saturation (SpO2) level and titrate the oxygen therapy accordingly 3
- Be aware of the potential risks of hyperoxia, including peripheral and coronary vasoconstriction, and direct cellular toxicity 4
- Consider the patient's medical history and any pre-existing conditions that could affect their response to oxygen therapy 3, 2