Pulmonology Book

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Chronic Dyspnea

Aka: Chronic Dyspnea
  1. See Also
    1. Acute Dyspnea
    2. Dyspnea History
    3. Dyspnea Causes
    4. Dyspnea in Cancer
    5. Acute Respiratory Failure
  2. Definition: Chronic Dyspnea
    1. Subjective difficult or distressed breathing >1 month
  3. Causes
    1. See Dyspnea Causes
  4. History
    1. See Dyspnea History
  5. Exam
    1. See Dyspnea
  6. Management: Empiric Therapy to consider
    1. Bronchodilator trial for episodic Dyspnea
    2. Proton Pump Inhibitor if GERD suspected
  7. Approach: Step 1 Evaluation for Dyspnea >1 month
    1. Complete Blood Count
    2. Chemistry panel (e.g. chem8)
    3. Chest XRay
    4. Electrocardiogram
    5. Pulse Oximetry (while walking)
    6. Spirometry or Peak Flow
  8. Approach: Step 2 Evaluation (Indicated if negative Step 1)
    1. Complete Pulmonary Function Testing (PFT)
    2. Arterial Blood Gas (ABG)
    3. Brain Natriuretic Peptide (BNP)
    4. D-Dimer
    5. Chest CT (high resolution)
    6. Echocardiogram
    7. Holter Monitor
    8. Exercise Stress Test
  9. Approach: Step 3 Evaluation (Indicated if negative Step 2)
    1. Consider cardiology evaluation for angiography
    2. Consider pulmonology for bronchoscopy and biopsy
    3. Consider esophageal pH and manometry testing
  10. References
    1. Fangman in Noble (2001) Primary Care, p. 175-8
    2. Karnani (2005) Am Fam Physician 71(8):1529-37 [PubMed]
    3. Wahls (2012) Am Fam Physician 86(2): 173-80 [PubMed]

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