A Structured Approach to Breathlessness

Tutorial presented by Tanya Howells, Respiratory Specialist Nurse, HDUHB.

In this tutorial Tanya outlines a structured approach to the assessment of a patient with breathlessness, including the history and clinical investigations, reversing the reversible causes, and ensuring the patients are clinically optimised. 

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
Mark as Understood


Southwark and Lambeth Breathlessness Assessment Algorithm

IMPRESS breathlessness algorithm

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