Dyspnea results from multiple interactions of signals and receptors in the autonomic nervous system, motor cortex, and peripheral receptors in the upper airway, lungs, and chest wall. The sensations are similar to that of thirst or hunger (i.e., an unignorable feeling of needing something). In a stable patient, management depends on the underlying etiology of the dyspnea.ĭyspnea is described as faster breathing accompanied by the sensations of running out of air and of not being able to breathe fast or deeply enough. If the patient is admitted to the emergency department or hospital, blood gases, ventilation-perfusion scan, D-dimer tests, and spiral computed tomography can help clarify the diagnosis. Diagnostic work-up includes pulse oximetry, complete blood count, electrocardiography, and chest radiography. Significant physical signs are fever, rales, wheezing, cyanosis, stridor, or absent breath sounds.

The physical examination should focus on vital signs and the heart, lungs, neck, and lower extremities. Pertinent history findings include cough, sore throat, chest pain, edema, and orthopnea. Differential diagnoses in children include bronchiolitis, croup, epiglottitis, and foreign body aspiration.

Other causes may be upper airway obstruction, metabolic acidosis, a psychogenic disorder, or a neuromuscular condition. Dyspnea is most commonly caused by respiratory and cardiac disorders. Subsequent management depends on the differential diagnosis established by a proper history, physical examination, and ancillary studies. Unstable patients typically present with abnormal vital signs, altered mental status, hypoxia, or unstable arrhythmia, and require supplemental oxygen, intravenous access and, possibly, intubation. Once the patient is in the office, the initial goal of assessment is to determine the severity of the dyspnea with respect to the need for oxygenation and intubation. Because patients may first seek care by calling their physician's office, telephone triage plays a role in the early management of dyspnea. Respiratory difficulty is a common presenting complaint in the outpatient primary care setting.

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