Breathlessness
In a breathlessness workup, gather and document onset and tempo, exercise tolerance, cardiac and respiratory history, oxygen saturation, and the spirometry, imaging and lab results already on file.
Heart and lungs: In these presentations, you often have an ECG, a troponin or a chest X-ray in the sources already.
Key takeaways
- Separate acute breathlessness from symptoms that built up over months.
- Quantify exercise tolerance so the next reader can see change.
- Gather spirometry, chest imaging and natriuretic peptide results before you write.
What this presentation is
Breathlessness has cardiac, respiratory, hematological, metabolic and deconditioning causes, and more than one often contributes in the same patient.
The tempo of onset shapes the workup. Sudden breathlessness raises different possibilities from breathlessness that has crept up over a year.
Gather these sources first
- The referral and earlier respiratory or cardiology letters
- Spirometry and peak flow records
- Chest X-ray and CT reports
- Natriuretic peptide, complete blood count and renal function
- Echocardiogram reports
- The current medication list and inhaler technique notes
Document these history questions
- Onset, tempo and duration
- Exercise tolerance, such as distance walked or stairs climbed
- Orthopnea and paroxysmal nocturnal dyspnea
- Cough, sputum, wheeze and chest pain
- Ankle swelling and weight change
- Smoking in pack-years and occupational exposures
- A breathlessness grade, such as the MRC dyspnea scale
Record these findings
- Respiratory rate, oxygen saturation and heart rate
- Chest examination findings
- Jugular venous pressure and peripheral edema
- Spirometry results with the date
- Hemoglobin and natriuretic peptide values
Ask about these red flags
Record each one as present or absent. Your local pathway decides what happens when one is present.
- Breathlessness at rest or inability to complete sentences
- Low oxygen saturation
- Chest pain or syncope
- Hemoptysis
- Unilateral leg swelling
- Stridor
Put these in the assessment draft
- The tempo and severity, with exercise tolerance quantified
- A differential weighing cardiac and respiratory causes
- The results that support or argue against each
- The red flags asked about and the answers
- A plan with investigations, referral and safety-netting advice
How Workup Desk helps
Add the spirometry, imaging reports, lab results and earlier letters to the workspace. Ask how the exercise tolerance described in the letters has changed over time.
Draft the assessment or a referral letter from the same sources and edit it. Check each quoted value against the report it came from.
Frequently asked questions
Why grade breathlessness on a scale?
A grade lets the next doctor see whether the patient is better or worse. Walks about 100 yards before stopping is clearer than limited exercise tolerance.
General guidance on what to gather and document, not advice about any individual patient. Local guidelines and your clinical judgment govern.