Gastroesophageal reflux disease/aspiration, neoplasiaĪmyotrophic lateral sclerosis, muscular dystrophies, phrenic nerve palsy, poliomyelitisįever, productive cough, shortness of breathįever, crackles, increased fremitus, bronchophonyĬhest radiography, chest CT, bronchoscopy/bronchoalveolar lavage, culture or biopsyĮxertional dyspnea, dry cough, malignancy, prescription or illicit drug use, chemical exposures Kyphoscoliosis, obesity, pleural disease/effusion, pneumothoraxĬhronic pulmonary emboli, idiopathic pulmonary hypertensionĪtrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardiaĬonstrictive pericarditis, pericardial effusion/tamponadeĪortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis To diagnose pulmonary arterial hypertension or certain interstitial lung diseases, right heart catheterization or bronchoscopy may be needed.īronchoalveolar carcinoma, chronic pneumoniaĭrugs (e.g., methotrexate, amiodarone) or radiation therapy, lymphangitic spread of malignancy, passive congestionĪsthma/bronchitis/bronchiectasis, bronchiolitis obliterans, chronic obstructive pulmonary disease, intrabronchial neoplasm, tracheomalacia Computed tomography of the chest is the most appropriate imaging study for diagnosing suspected pulmonary causes of chronic dyspnea. Pulmonary function studies can be used to identify emphysema and interstitial lung diseases. Measurement of brain natriuretic peptide levels may help exclude heart failure, and d-dimer testing may help rule out pulmonary emboli. Initial testing in patients with chronic dyspnea includes chest radiography, electrocardiography, spirometry, complete blood count, and basic metabolic panel.

Examination findings (e.g., jugular venous distention, decreased breath sounds or wheezing, pleural rub, clubbing) may be helpful in making the diagnosis. Patients' descriptions of the sensation of dyspnea may be helpful, but associated symptoms and risk factors, such as smoking, chemical exposures, and medication use, should also be considered. The clinical presentation alone is adequate to make a diagnosis in 66 percent of patients with dyspnea. The etiology of dyspnea is multi-factorial in about one-third of patients.

Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders. Dyspnea that is greater than expected with the degree of exertion is a symptom of disease. The perception of dyspnea varies based on behavioral and physiologic responses. Chronic dyspnea is shortness of breath that lasts more than one month.

Emphysema and nocturnal asthma