Some Causes of Chronic* Dyspnea
Cause | Suggestive Findings | Diagnostic Approach† |
|---|---|---|
Pulmonary causes | ||
Progressive dyspnea and cough Occupational and environmental exposure (occupational lung disease such as silicosis, hypersensitivity pneumonitis) may be present Smoking history, family history, medication history, or radiation history may be present Fine crackles, frequently accompanied by dry cough Clubbing | High-resolution chest CT Pulmonary function testing | |
Extensive smoking history, barrel chest, and poor air entry and exit or wheezing (COPD) Wheeze, cough, chest tightness, episodic symptoms, characteristic triggers (asthma) | Chest radiograph Pulmonary function testing (at initial evaluation) | |
Pleuritic chest pain, lung field that is dull to percussion and has diminished breath sounds Sometimes history of cancer, heart failure (due to increased pulmonary capillary pressure), rheumatoid arthritis, systemic lupus erythematosus, or acute pneumonia | Chest radiograph Often chest CT and thoracentesis | |
Neuromuscular disease | Progressive dyspnea in patients with a known neuromuscular impairment (eg amyotrophic lateral sclerosis or muscular dystrophies) | Pulmonary function testing EMG or nerve conduction testing Sometimes blood tests to determine the cause |
Cardiac causes | ||
Crackles, S3 gallop, and signs of central or peripheral volume overload (eg, elevated neck veins, peripheral edema) Orthopnea or paroxysmal nocturnal dyspnea | Chest radiograph Echocardiography | |
Loud S2, parasternal heave, elevated jugular venous pressure, murmur of tricuspid regurgitation | Echocardiography Right heart catheterization | |
Substernal chest pressure with or without radiation to the arm or jaw, often provoked by physical exertion, particularly in patients with risk factors for CAD | ECG Cardiac stress testing Sometimes cardiac catheterization | |
Other causes | ||
Normal lung examination and pulse oximetry measurement Sometimes systolic heart murmur due to increased flow | Complete blood count | |
Physical deconditioning | Dyspnea only on exertion in patients with sedentary lifestyle | History and physical examination |
* Chronic dyspnea that has lasted for weeks to years. In many of these disorders, dyspnea is initially present on exertion before progressing to dyspnea at rest. | ||
† Most patients should have pulse oximetry and, unless symptoms are clearly a mild exacerbation of a known chronic disease, chest radiograph. | ||
CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; CT = computed tomography; ECG = electrocardiogram; EMG = electromyography; S2 = second heart sound; S3 = third heart sound. | ||