Initial Workup for Shortness of Breath and Lightheadedness with Coughing or Laughing

Key History Elements to Assess

The American Thoracic Society suggests determining if symptoms are triggered specifically by coughing, laughing, talking, or other activities that involve changes in intrathoracic pressure 1
The British Thoracic Society recommends assessing for association with eating or drinking, which may suggest aspiration or reflux-related cough 2
The American College of Chest Physicians advises evaluating timing and characteristics of symptoms - whether acute, subacute (3-8 weeks), or chronic (>8 weeks) 3
The European Respiratory Society suggests documenting any aggravating factors such as changes in air temperature, scents, aerosols, or exercise 2
The American Heart Association recommends noting any associated symptoms like chest discomfort, palpitations, or irregular heartbeat 4

The British Thoracic Society recommends vital signs with particular attention to respiratory rate, heart rate, and oxygen saturation 5
The American College of Chest Physicians advises thorough cardiopulmonary examination to assess for abnormal heart sounds, murmurs, or lung sounds 6
The European Respiratory Society suggests evaluation of the upper airway and oropharynx for signs of inflammation or irritation 5
The American Heart Association recommends assessment for signs of hyperventilation or dysfunctional breathing patterns 4

The American College of Chest Physicians recommends chest radiograph to rule out structural abnormalities or infiltrates 7, 5
The American Thoracic Society suggests spirometry with bronchodilator testing to assess for asthma or other obstructive lung diseases 3
The American Heart Association recommends ECG to evaluate for cardiac arrhythmias or ischemic changes 8
The American College of Cardiology suggests pulse oximetry at rest and with exertion 8

The American Heart Association recommends evaluating for hyperventilation syndrome, which can cause lightheadedness and may be triggered during coughing or laughing 4
The American College of Cardiology suggests assessing breathing patterns during normal respiration and during episodes 8
The American Thoracic Society recommends determining if there is evidence of cough hypersensitivity syndrome, characterized by troublesome coughing triggered by low levels of thermal, mechanical, or chemical exposure 1
The American College of Chest Physicians advises assessing for common causes of chronic cough including upper airway cough syndrome (UACS), asthma, non-asthmatic eosinophilic bronchitis (NAEB), and gastroesophageal reflux disease (GERD) 3

The British Thoracic Society recommends evaluating for significant hemoptysis 5
The American College of Chest Physicians suggests evaluating for prominent systemic illness 5
The European Respiratory Society recommends evaluating for suspicion of pulmonary embolism 5
The American Thoracic Society advises evaluating for increasing breathlessness with fever, malaise, or purulent sputum 5

The British Thoracic Society recommends proceeding with immediate chest imaging and appropriate specialist referral if symptoms suggest possible serious underlying condition (hemoptysis, significant systemic symptoms) 5
The American College of Chest Physicians suggests beginning with evaluation for common causes of chronic cough (UACS, asthma, GERD) if patients have predominant cough-triggered symptoms without red flags 3
The American Heart Association recommends evaluating for possible cardiac causes with appropriate cardiac testing if patients have predominant lightheadedness during coughing/laughing 8
The American College of Cardiology suggests considering breathing retraining techniques if patients have symptoms suggestive of dysfunctional breathing 4