When reviewing a patient with breathlessness, it is important to remember the distinction between breathlessness and hypoxia; breathlessness is a symptom, and hypoxia is a physiological measurement. Patients who are breathless, are not necessarily hypoxic.

There are many approaches to breathlessness, and a few have been linked below, but the following steps should help practitioners identify the underlying cause and manage patients who are presenting with breathlessness: 

Clinical history and Investigations

• Ask about the patient’s current and past smoking history
• Assess for anxiety as an underlying cause
• Ask about physical activity levels
• Check SpO2
• Routine bloods including FBC
• Perform a spirometry measurement
• Consider a chest x-ray
• Consider an ECG for patients with cardiac symptoms 
• Consider sending a sputum sample 

Check for reversible causes of the breathlessness

• Antibiotic therapy if the patient is have an exacerbation of their underlying lung condition 
• Cardiac causes of breathlessness such as ankle oedema
• Iron supplements for patients who are anaemic

Optimisation of underlying conditions

• Review inhaler technique if the patient takes inhalers
• Review a patient’s inhaled corticosteroids to manage inflammation in the airways
• Referral to specialist asthma teams for consideration for biologic therapies
• Consider mucolytic therapy if the patient is experiencing excessive secretions
• Refer for pulmonary rehabilitation 
• Consider referral for cognitive behavioural therapy
• Review the patient’s diuretics if they have ankle swelling