From the Guidelines
The workup for shortness of breath should begin with a thorough history and physical examination, followed by targeted diagnostic tests based on suspected causes, as recommended by the most recent guidelines 1.
Initial Evaluation
The initial evaluation should include pulse oximetry, complete blood count, basic metabolic panel, chest X-ray, and electrocardiogram.
- Pulse oximetry to assess oxygen saturation
- Complete blood count to evaluate for anemia or infection
- Basic metabolic panel to assess electrolyte balance and renal function
- Chest X-ray to evaluate for pulmonary abnormalities
- Electrocardiogram to evaluate for cardiac arrhythmias or ischemia
Additional Testing
Additional tests may include:
- D-dimer and CT pulmonary angiography if pulmonary embolism is suspected
- BNP or NT-proBNP for heart failure
- Arterial blood gases to assess gas exchange
- Pulmonary function tests to evaluate for obstructive or restrictive lung diseases
- Echocardiogram to evaluate cardiac function
- High-resolution CT scan for interstitial lung disease
- Sleep studies if sleep-disordered breathing is suspected
Specialized Tests
Specialized tests like cardiopulmonary exercise testing may help differentiate cardiac from pulmonary causes in complex cases. The diagnostic approach should be tailored to the patient's age, risk factors, and clinical presentation, as shortness of breath can result from pulmonary, cardiac, hematologic, neuromuscular, or psychological conditions. Treatment depends on identifying the underlying cause, which may range from asthma requiring bronchodilators and corticosteroids to heart failure requiring diuretics and ACE inhibitors, as supported by the American College of Physicians guideline 1.
From the Research
Shortness of Breath Workup
- Shortness of breath is a common symptom in patients with acute heart failure (AHF) and requires prompt identification and management 2.
- The management of acute shortness of breath should follow an algorithm incorporating simultaneous assessment and resuscitation 3.
- A formal diagnosis is essential to guide risk stratification, prognostication, and treatment, but should not delay resuscitation 3.
Assessment and Diagnosis
- The assessment of dyspnea in clinical practice involves evaluating the patient's airway, breathing, and circulation 2.
- A thorough history and physical examination are crucial in determining the underlying cause of shortness of breath 3.
- The differential diagnosis of shortness of breath is broad and includes cardiac, pulmonary, and other causes 3, 4.
Treatment
- Ensuring adequate oxygenation and ventilation is a key goal in the management of shortness of breath 2.
- Combination bronchodilator therapy with ipratropium and albuterol may be effective in treating chronic obstructive pulmonary disease (COPD) 5, 6.
- The combination of ipratropium and albuterol has been shown to be more effective than either agent alone in improving lung function in patients with COPD 5.