Breathlessness in older people

Breathlessness in the elderly is a common clinical problem but should not be considered an inevitable consequence of the aging process. Because of the diverse causes and the possibility of more than one underlying mechanism, the approach to the breathless patient needs to be comprehensive with investigations guided by specific clinical questions. Once the underlying reversible factors have been identified and treated as far as practicable, management of the chronically breathless patient is based on symptom relief, exercise conditioning, optimisation of breathing patterns and patient education. Interventions should be objectively evaluated using symptom scores or a measure of exercise tolerance rather than a physiological measure alone. As there is the potential for harm (including cost), treatments offering no benefit should be promptly withdrawn.