title: A woman with breathlessness: a practical approach to diagnosis and management.
abstract: Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV). Clinicians need to be alert to the possibility of atypical presentations (such as pain-free variants of angina) and less common conditions (including chronic thromboembolic pulmonary hypertension) in order not to overlook important potentially treatable conditions.
authors.affiliation: Family Physician Airways Group of Canada, Richmond Hill, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Kaplan
authors.forename: Kevin
authors.initials: K
authors.lastname: Gruffydd-Jones
authors.forename: Frederik
authors.initials: F
authors.lastname: van Gemert
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kirenga
authors.forename: Andrew R L
authors.initials: AR
authors.lastname: Medford
mesh_terms: D000420:Albuterol / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000175:diagnosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol