Management of Chronic Shortness of Breath

Initial Assessment

The American College of Cardiology recommends confirming that previous cardiac workup remains relevant by checking for any new cardiac symptoms or changes in clinical presentation 1
The American Thoracic Society suggests evaluating asthma control status by assessing frequency of symptoms, medication compliance, and potential exacerbating factors 2, 3
The American Academy of Allergy, Asthma, and Immunology recommends assessing for possible dysfunctional breathing patterns which can mimic or exacerbate asthma symptoms, particularly in patients with anxiety 3, 4
The American Thoracic Society suggests considering performing spirometry to objectively measure current lung function and response to bronchodilators 3

The National Asthma Education and Prevention Program recommends optimizing controller medications according to current guidelines, ensuring patient is on appropriate inhaled corticosteroids (ICS) with or without long-acting beta-agonists (LABAs) 2
The American Academy of Allergy, Asthma, and Immunology suggests providing short-acting beta-agonists (SABAs) for rescue therapy, but monitoring for overuse which may indicate poor asthma control 3
The American Academy of Allergy, Asthma, and Immunology recommends considering adding leukotriene modifiers which can be used daily or intermittently to prevent exercise-induced bronchoconstriction without leading to tolerance 3, 5

The American Thoracic Society suggests that for acute anxiety episodes with associated dyspnea, short-acting benzodiazepines such as alprazolam may be beneficial, particularly when panic symptoms are present 2
The American Psychiatric Association recommends considering buspirone starting at 5 mg twice daily (maximum 20 mg three times daily), which is particularly effective for anxiety in patients with chronic respiratory conditions 2, 6

The American Thoracic Society recommends implementing pulmonary rehabilitation which combines cardiovascular fitness, self-confidence building, and stress control techniques 2
The American Thoracic Society suggests teaching relaxation techniques such as yoga which may help manage both anxiety and dyspnea 2
The American Thoracic Society recommends considering oxygen therapy during exercise if desaturation is documented, as this can increase exercise capacity 2
The American Academy of Allergy, Asthma, and Immunology suggests providing education on dysfunctional breathing patterns and techniques to normalize breathing during anxiety episodes 3, 4

The American Academy of Allergy, Asthma, and Immunology recommends scheduling regular follow-up visits to assess response to therapy and adjust treatment as needed 3
The American College of Cardiology suggests reassessing cardiac status if symptoms change or worsen despite optimal management of asthma and anxiety 1
The American Thoracic Society recommends considering home pulse oximetry monitoring to objectively assess oxygen saturation during symptomatic episodes 2

The American College of Cardiology warns against attributing all symptoms to anxiety without thoroughly excluding organic causes, especially in elderly patients 1, 4
The American Thoracic Society cautions against long-term use of benzodiazepines due to risk of dependence and potential respiratory depression in patients with underlying lung disease 2