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Evaluation of chronic dyspnea.

Neel G Karnani1, Gary M Reisfield, George R Wilson

  • 1Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville, Florida 32209, USA. neel.karnani@jax.ufl.edu

American Family Physician
|May 4, 2005
PubMed
Summary

Chronic dyspnea, often caused by cardiopulmonary disease, requires accurate diagnosis for effective treatment. Initial tests guide further investigation for conditions like asthma or heart failure.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Internal Medicine

Background:

  • Chronic dyspnea, defined as shortness of breath lasting over a month, frequently stems from cardiopulmonary conditions.
  • Cardiopulmonary diseases account for approximately two-thirds of chronic dyspnea cases, necessitating precise diagnosis for appropriate management.
  • Key conditions include asthma, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic causes, collectively representing 85% of cases.

Purpose of the Study:

  • To outline a diagnostic approach for chronic dyspnea.
  • To emphasize the importance of accurate diagnosis for guiding treatment decisions.
  • To detail initial and advanced diagnostic tests for various cardiopulmonary conditions.

Main Methods:

  • History and physical examination to guide initial diagnostic test selection.
  • Initial tests include electrocardiogram, chest radiograph, pulse oximetry, spirometry, complete blood count, and metabolic panel.
  • Further investigations such as pulmonary function testing, high-resolution computed tomography, echocardiography, brain natriuretic peptide levels, ventilation perfusion scans, Holter monitoring, cardiac catheterization, esophageal pH monitoring, lung biopsy, and cardiopulmonary exercise testing are employed if initial results are inconclusive.

Main Results:

  • The diagnostic process involves a stepwise approach, starting with basic clinical evaluation and tests.
  • Specific tests are highlighted for their utility in diagnosing conditions like interstitial lung disease (HRCT), congestive heart failure (echocardiography, BNP), and obstructive lung diseases (PFTs).
  • A comprehensive range of advanced tests is available for complex or unclear cases.

Conclusions:

  • Accurate diagnosis of chronic dyspnea is critical as treatment varies significantly with the underlying cause.
  • A systematic diagnostic strategy, from initial assessment to advanced testing, is essential for identifying the cause of chronic dyspnea.
  • Effective management of chronic dyspnea relies on timely and precise identification of cardiopulmonary or other underlying conditions.

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