Chronic Dyspnea
Aka: Chronic Dyspnea
II. Definition: Chronic Dyspnea
- Subjective difficult or distressed breathing >1 month
III. Causes
- See Dyspnea Causes
IV. History
- See Dyspnea History
V. Exam
- See Dyspnea
VI. Management: Empiric Therapy to consider
- Bronchodilator trial for episodic Dyspnea
- Proton Pump Inhibitor if GERD suspected
VII. Approach: Step 1 Evaluation for Dyspnea >1 month
- Complete Blood Count
- Chemistry panel (e.g. chem8)
- Chest XRay
- Electrocardiogram
- Pulse Oximetry (while walking)
- Spirometry or Peak Flow
VIII. Approach: Step 2 Evaluation (Indicated if negative Step 1)
- Complete Pulmonary Function Testing (PFT)
- Arterial Blood Gas (ABG)
- Brain Natriuretic Peptide (BNP)
- D-Dimer
- Chest CT (high resolution)
- Echocardiogram
- Holter Monitor
- Exercise Stress Test
IX. Approach: Step 3 Evaluation (Indicated if negative Step 2)
- Consider cardiology evaluation for angiography
- Consider pulmonology for bronchoscopy and biopsy
- Consider esophageal pH and manometry testing
X. References
- Fangman in Noble (2001) Primary Care, p. 175-8
- Karnani (2005) Am Fam Physician 71(8):1529-37 [PubMed]
- Wahls (2012) Am Fam Physician 86(2): 173-80 [PubMed]