Chronic dyspnea: diagnostic challenges and evidence-based management strategies

Chronic dyspnea, defined as shortness of breath lasting over a month, results from a complex interplay of environmental, physiological, and psychological factors. The American Thoracic Society recognizes it as a significant predictor of all-cause mortality, emphasizing the importance of accurate and timely diagnosis. It is commonly linked to cardiac or pulmonary conditions such as asthma, COPD, heart failure, pneumonia, and coronary artery disease, which account for nearly 85% of cases. Other factors include obesity, anxiety, pregnancy, or occupational exposures.

A structured diagnostic approach is essential, beginning with a comprehensive history and physical examination. Initial testing should include pulse oximetry, complete blood counts, and imaging, such as chest radiography and spirometry. If no clear cause is found, second-line noninvasive tests, including echocardiography, stress tests, and high-resolution chest CT, are recommended. Invasive tests, like bronchoscopy or cardiac catheterization, are reserved for unresolved cases and require specialist consultation.

Treatment focuses on addressing the underlying cause, optimizing patient recovery, and alleviating dyspnea symptoms. Options include pulmonary rehabilitation for COPD, oxygen therapy for those with severe hypoxia, and cognitive behavioral therapy to manage anxiety. The six-minute walk test serves as a valuable tool for monitoring treatment efficacy, especially in patients with heart or lung diseases. A multidisciplinary approach is crucial, with primary care physicians playing a key role in managing these patients.