Dyspnea History

Aka: Dyspnea History

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II. History: Dyspnea Severity

  1. Exertional Dyspnea (early finding)
    1. Early finding in all Dyspnea
    2. Deconditioning
    3. Disproportionate Exertional Dyspnea
      1. Upper airway obstruction
      2. Exercise-Induced Asthma
      3. Severe Pulmonary Hypertension
  2. Dyspnea at rest
    1. Dyspnea out of proportion to physical findings and objective data
      1. Anxiety (esp. if not worsened with exertion)
  3. Orthopnea (most severe, graded by number of pillows)
    1. Congestive Heart Failure (Paroxysmal Nocturnal Dyspnea)
    2. Obesity
    3. Obstructive Sleep Apnea
    4. Pulmonary Hypertension
    5. Diaphragmatic paralysis
    6. Gastroesophageal Reflux disease
    7. Chronic Sinusitis with postnasal drainage

III. History: Dyspnea Timing

  1. Nocturnal Dyspnea
    1. Asthma
    2. Chronic Obstructive Pulmonary Disease (COPD)
    3. Congestive Heart Failure (CHF)
  2. Orthopnea or Paroxysmal Nocturnal Dyspnea
    1. Congestive Heart Failure
    2. Emphysema
  3. Postprandial Dyspnea
    1. Gastroesophageal Reflux disease
    2. Aspiration
    3. Food Allergy

IV. History: Dyspnea Contributing Factors

  1. Medications
    1. See Medication Causes of Dyspnea
  2. Tobacco Abuse or Vaping
    1. Emphysema
    2. Chronic Bronchitis
    3. Asthma
  3. Occupational exposure to dust, Asbestos, or volatiles
    1. Interstitial Lung Disease
  4. Organic dust exposure
    1. Hypersensitivity pneumonitis
  5. Workplace or home multiple acute flu-like illness in humans and pets (esp. faulty heaters)
    1. Carbon Monoxide Poisoning

V. History: Associated conditions

  1. Allergic Rhinitis, Wheezing, or atopic Family History
    1. Asthma
  2. Anxiety, Lightheadedness, finger and perioral tingling
    1. Panic Attack
    2. Hyperventilation
  3. Chest Trauma
    1. Pneumothorax
    2. Chest Wall Pain
  4. Immunocompromised condition (e.g. AIDS)
    1. Aspergillus
    2. Coccidioidomycosis
    3. Cytomegalovirus
    4. Legionella
    5. Pneumocystis carinii Pneumonia
    6. Tuberculosis
  5. Family History
    1. Atypical Cystic Fibrosis
    2. Alpha-1-Antitrypsin Deficiency
    3. Pulmonary Hypertension
    4. Pulmonary Fibrosis

VI. History: Characteristics and Associated Symptoms

  1. Pleuritic Chest Pain
    1. Pericarditis
    2. Pulmonary Embolism
    3. Pneumothorax
    4. Pneumonia
  2. Dysphagia
    1. Gastroesophageal Reflux
    2. Aspiration Pneumonia
  3. Persistent Cough
    1. Asthma
    2. Pneumonia
    3. Congestive Heart Failure
    4. Gastroesophageal Reflux
    5. Chronic Bronchitis
    6. Bronchiectasis
  4. Hemoptysis
    1. Lung Cancer
    2. Pneumonia
    3. Bronchiectasis
    4. Mitral Stenosis
    5. Arteriovenous Malformation
  5. Wheezing
    1. See Wheezing
    2. Asthma
    3. Chronic Obstructive Lung Disease
    4. Congestive Heart Failure

VII. History: Screening Tools

  1. COPD Population Screener Questionnaire
  2. Lung Function Questionnaire

VIII. References

  1. Braithwaite in Marx (2002) Rosen Emergency Med, p. 155
  2. Budhwar (2020) Am Fam Physician 101(9):542-8 [PubMed]
  3. Morgan (1998) Am Fam Physician 57:711-6 [PubMed]

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