Uncomfortable breathing sensation with awareness of respiratory distress.

Nonspecific symptom provoked by lung, vascular and respiratory muscle receptors.

Prevalence 7-10%.

1-4% of patients seeing a primary care physician complain of dyspnea.

Associated with female sex, increasing weight, smoking, anxiety, and physical exertion.

On exertion affects approximately 1/2 of Americans.

An integrated measure of pulmonary, cardiac, vascular function and state of conditioning.

Differential diagnosis includes extrapulmonary processes.

Allows measurement of pulmonary function for long-term monitoring of disease progression in response to therapy.

Causes more than 2.5 million physician visits per year in the U.S.

Caused by a number of disorders including: congestive heart failure, chronic obstructive pulmonary disease, asthma, metabolic acidosis, anxiety, deconditioned status, upper airway obstruction, obesity and neuromuscular weakness.

Dyspnea could be attributed to many causes-infections, obstructive or restrictive lung disease, or pleural disease, pulmonary vascular causes-pulmonary hypertension, pulmonary embolism, cardiac causes-congestive heart failure or, myocardial ischemia, arrhythmias, or pericardial effusion, hematologic causes-severe anemia, or metabolic causes-acid-base disturbances or oxidative myopathies

May serve as an anginal equivalent marker for underlying coronary artery disease.

Its presence is a significant predictor of death from any cause and of cardiac causes.

Worsens with exertion promoting sedentary status and increasing frailty and decreased quality of life.

Patients with unexplained dyspnea have a high likelihood of ischemia and an increased risk of cardiac events.

Intrinsic lung disease divided into diseases of the blood vessels, airways and parenchyma.

Pleural effusions can lead to a mismatch between ventilation and perfusion and can manifest as dyspnea.

Cardiac causes include coronary ischemia and CHF.

Exertional dyspnea can occur with anemia when oxygen-carrying capacity of the blood does not meet metabolic demands.

May be associated with metabolic acidosis as alveolar ventilation increases to compensate for decreased blood pH values.

Anxiety may be considered as a cause of dyspnea after organic reasons have been ruled out.

New onset requires: a complete history and physical, basic laboratory tests, EKGs, chest x-Ray, and possibly spirometry, BNP, and CT chest.

Chronic breathlessness is defined as breathlessness at rest or with low levels of exertion that persist despite optimal treatment for the underlying conditions, and may affect many people with COPD.

Chronic breathlessness often restricts activities of daily living and is associated with decreased physical activity and muscular and cardiovascular deconditioning, which which further worsens restlessness.

Chronic breathlessness is associated with anxiety and depression, reduce health related quality of life, and increased use of healthcare services in mortality.

Spirometry has the highest diagnostic yield, followed by chest imaging by chest X-Ray or CT.

Spirometry includes measurement of exhaled or inhaled air during forced maneuvers?

The FVC , the forced vital capacity is the amount of air that can be forcefully expelled, beginning with the lungs completely full, total lung capacity and blowing maximally until it as empty as possible at residual volume.

In dyspneic patients with normal spirometry and lung imaging other tests such as lung diffusion capacity and exercise testing provide minimal diagnostic accuracy.

Possible causes of abdominal bloating and shortness of breath:

chronic obstructive pulmonary disease (COPD)





anxiety or panic disorder

lactose intolerance

irritable bowel syndrome (IBS)


hiatal hernia



ovarian cancer

pancreatic insufficiency

Non-Hodgkin’s lymphoma

cystic fibrosis

peripheral neuropathy

Legionnaires’ disease


celiac disease

Abdominal bloating can affect the diaphragm, a muscular partition between the chest and abdomen.

The diaphragm assists in breathing, which means bloating can lead to shortness of breath, if the pressure in the abdomen is enough to restrict the movement of the diaphragm.

Intestinal stool, irritable bowel syndrome, celiac disease, lactose intolerance, constipation, ileus, bowel obstruction, and gastroparesis could cause bloating and shortness of breath.

Among patients with COPD and severe chronic breathlessness, daily low-dose, extended release morphine does not significantly reduce the intensity of worst breathlessness one week of treatment.

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