Assessment and Management of Acute Shortness of Breath

Patient Evaluation

The American Thoracic Society recommends assessing the onset and timing of symptoms, including acute onset (within hours to days) versus subacute/chronic progression (weeks to months), to determine the underlying cause of shortness of breath 1
The European Respiratory Society suggests evaluating the patient's current oxygen saturation on room air and response to supplemental oxygen to guide oxygen therapy 3
The American College of Chest Physicians recommends assessing respiratory rate at presentation, as it is a critical vital sign indicator of respiratory distress 1
The Intensive Care Medicine journal suggests evaluating the presence of respiratory distress signs, such as increased work of breathing, use of accessory muscles, and inability to speak in full sentences, to determine the severity of respiratory failure 4

The American College of Cardiology recommends identifying patients with known COPD or fixed airflow obstruction, as they require different oxygen targets (88-92% versus 94-98%) 7, 3
The European Society of Intensive Care Medicine suggests considering cystic fibrosis, neuromuscular disease affecting respiratory muscles, and chest wall deformities or morbid obesity as risk factors for hypercapnic respiratory failure 3
The American Thoracic Society recommends evaluating the patient's past medical history, including COPD, asthma, or other chronic lung disease, to determine the oxygen titration strategy 7, 3

The American College of Emergency Physicians suggests assessing for cardiac-related symptoms, such as chest pain or pressure, facial or peripheral edema, orthopnea, and palpitations or syncope, to consider acute coronary syndrome or heart failure 1
The European Respiratory Society recommends evaluating pulmonary-related symptoms, such as cough, wheezing, hemoptysis, and pleuritic chest pain, to consider pulmonary embolism or pneumonia 4, 5, 6
The Intensive Care Medicine journal suggests assessing for systemic signs, such as fever or chills, confusion or altered mental status, and cyanosis, to consider sepsis or other systemic infections 4

The American College of Chest Physicians recommends evaluating the patient's response to supplemental oxygen administration, including oxygen saturation improvement, to guide oxygen therapy 3
The European Society of Intensive Care Medicine suggests assessing the patient's response to bronchodilator therapy, if administered, to consider asthma or COPD exacerbation 5, 6
The American Thoracic Society recommends evaluating the patient's tolerance of positioning, such as semi-recumbent versus lateral, to consider respiratory muscle fatigue or other respiratory complications 4