Approach to Assessment of Shortness of Breath

Definition and Classification

Dyspnea is a subjective experience of breathing discomfort that varies in intensity, often described as breathlessness or shortness of breath, as defined by the American College of Radiology 1
Chronic dyspnea is defined as shortness of breath lasting >4 to 8 weeks, according to the American College of Radiology 1, 2

The American College of Cardiology recommends considering cardiovascular causes, such as congestive heart failure, myocardial ischemia, and valvular heart disease, in patients with dyspnea 1, 5, 6
The American College of Radiology suggests considering pulmonary causes, such as chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease, in patients with dyspnea 1, 2, 7
Other systems, such as neuromuscular disorders, obesity, and deconditioning, should also be considered in the differential diagnosis of dyspnea, as recommended by the American College of Cardiology and the American College of Radiology 1, 6, 9

The American Journal of Respiratory and Critical Care Medicine recommends asking essential questions, such as onset, duration, timing, and severity of dyspnea, as well as associated symptoms, to characterize the dyspnea 3
The American College of Cardiology suggests assessing for risk factors, such as hypertension, diabetes, and atrial fibrillation, in patients with dyspnea 6

The American College of Radiology recommends chest radiography as the first-line imaging modality for patients with dyspnea, with expected findings including cardiomegaly, infiltrates, and pleural effusion 1, 2, 7
The American College of Cardiology suggests using BNP or NT-proBNP to diagnose heart failure, with a BNP >100 pg/mL having a sensitivity of 0.96 and specificity of 0.61 for heart failure 5

The American College of Cardiology recommends increasing diuretic therapy and optimizing afterload reduction for patients with heart failure and dyspnea 4
The American College of Radiology suggests using bronchodilators, systemic corticosteroids, and supplemental oxygen for patients with COPD or asthma exacerbation and dyspnea 7, 10

The American College of Cardiology recommends referring patients with cardiac symptoms or risk factors, suspected heart failure with preserved ejection fraction, or elevated TRV on echocardiography to cardiology 6, 9
The American College of Radiology suggests referring patients with chronic dyspnea of unclear etiology, suspected interstitial lung disease, or post-COVID complications to pulmonology 1, 7, 9