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1、Step-by-stepdiagnosticapproachofdyspnea.ClinicalhistoryCarefulhistory-takingisthemostusefulfirststepinelucidatingtheaetiologyofdyspnoea.Severalfactorsneedtobeaddressedintheclinicalhistorywhenconstructingtheinitialdifferentialdiagnosis.Timecourse·Acutedy
2、spnoeaappearssuddenlyorinamatterofminutes.Ittypicallyindicatesacuteandsevereconditionsthatmaybelife-threatening.Examplesofconditionscausingsudden-onsetdyspnoeaincludeacutepulmonaryembolism,myocardialinfarction,acuteheartvalveinsufficiency,pneumothorax,a
3、naphylaxis,foreignbodyaspiration,pulmonaryoedema,orcardiactamponade.[16]·Subacutedyspnoeadevelopsoverhourstodays.Commoncausesincludeacuteasthma,exacerbationofCOPD,orpulmonaryoedema.Lesscommoncausesincludemyocarditis,superiorvenacavasyndrome,acuteeosinop
4、hilicpneumonia,orcardiactamponade.[16][17][18]·Chronicdyspnoeadevelopsoverweekstomonths.Itisassociatedwithchronicpathology,suchascongestiveheartfailure,COPD,cardiomyopathy,idiopathicpulmonaryfibrosis,pulmonaryvasculardisease,pulmonaryhypertension,valvul
5、arheartdisease,oranaemia.[19]Lesscommoncausesincludemusculardystrophies,kyphoscoliosis,amyotrophiclateralsclerosis,pulmonaryalveolarproteinosis,chroniceosinophilicpneumonia,uraemia,orconstrictivepericarditis.[18][20][21][22][23]·Recurrentdyspnoeamayindi
6、cateparoxysmaltachycardiasorintermittentcompleteheartblock.Severity·Thereisnouniversallyagreedmeasureofdyspnoea;severalscalesareavailableinbothresearchandclinicalpractice.[24]·Dyspnoeaishighlysubjective,and,foragivenleveloffunctionalimpairment,severityv
7、arieswidely.·Severedyspnoeaistypicallyaccompaniedbyassociatedsymptomsandismorelikelytobelife-threatening.Itmaybeassociatedwithacuteasthma,tensionpneumothorax,acuteupperairwayobstruction,massivepulmonaryembolism,ormyocardialinfarction.Milddyspnoeamaybeas
8、olesymptomandmayindicateabenignaetiology.ItmaybecausedbystableCOPD,deconditioning,non-criticalairwayobstruction,ornormalageing.Associatedsymptoms·Dyspnoeaoftenoccurswithothersymptoms,andtheirco-existencemayhelptolocalisetheorigin
