title: When the chief complaint is (or should be) dyspnea in adults.
abstract: Dyspnea, "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity," is an important and challenging complaint associated with a wide variety of adverse clinical outcomes, including hospitalizations for chronic obstructive pulmonary disease and cardiac mortality. Although up to 85% of cases are caused by asthma, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, cardiac ischemia, congestive heart failure, or psychogenic disorders, a systematic approach can help to identity uncommon, but important, causes of dyspnea. In this review that includes clinical examples as well as a didactic review of currently available information, we suggest a step-wise approach to the evaluation of the adult patient with dyspnea. It is also important to avoid 3 possible pitfalls: accepting a cause for dyspnea in which the element identified is only part of a syndrome which includes that element; accepting a single cause for dyspnea when the cause is multifactorial; and failing to recognize a diagnosis and cause of dyspnea is incorrect and has been assumed without rigorous confirmation, when a patient with a specific diagnosis is referred for "failing to respond to treatment."
authors.affiliation: Wake Forest School of Medicine, Center for Genomics and Personalized Medicine Research, Winston-Salem, NC. Electronic address: sppeters@wakehealth.edu.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D011653:Pulmonary Diffusing Capacity; D012129:Respiratory Function Tests
keywords: Asthma; Cardiopulmonary exercise testing; Chief complaint; Differential diagnosis; Dyspnea; Pulmonary function tests