An Algorithmic Approach to Chronic Dyspnea

• related: Pulmonology
• tags: #literature #pulmonology

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Intro

• PFT: COPD and asthma
• CXR: lung and pleural disorder
• Labs: anemia, thyroid disorder, and heart failure

Protocol

• Move from tier 1 to 2 then to 3 if no clear diagnosis
• Stop at any tier if there’s clear diagnosis
• tier 2 does not include echo
• if CPET points to cardiac: echo or stress echo
• Tier 3: Other organ focused testing includes chest CT, bronchoscopy, echo, nuclear stress, RHC based on previous results.
• Normal Tier 1 and 2 study suggest dyspnea is non-cardiorespiratory, and Tier 3 studies were not necessary¹

Links to this note

• Pulmonology

  • An Algorithmic Approach to Chronic Dyspnea

• cardiopulmonary exercise test CPET

  • An Algorithmic Approach to Chronic Dyspnea

• diagnosis of asthma includes typical symptoms and variable airflow limitation

  • [^1]: An Algorithmic Approach to Chronic Dyspnea

• obesity related dyspnea has normal VO2 max and reduced VO2 per kg

  • [^1]: An Algorithmic Approach to Chronic Dyspnea

• order CPET to diagnose chronic dyspnea and assess preoperative risks

  • [^1]: An Algorithmic Approach to Chronic Dyspnea [^3]: SEEK Questionnaires

• terminologies and ranges in CPET testing

  • [^1]: Cardiopulmonary exercise testing, A contemporary and versatile clinical tool [^3]: An Algorithmic Approach to Chronic Dyspnea [^4]: Principles of Exercise Testing and Interpretation [^5]: A Practical Approach? [^6]: SEEK CPET examples

• difference between asthma, copd, emphysema on PFT

  • [^1]: An Algorithmic Approach to Chronic Dyspnea [^3]: Gelb AF, Yamamoto A, Verbeken EK, et al. Unraveling the pathophysiology of the asthma-COPD overlap syndrome: unsuspected mild centrilobular emphysema is responsible for loss of lung elastic recoil in never smokers with asthma with persistent expiratory airflow limitation. Chest. 2015;148(2):313-320.

Footnotes

1. Pratter MR, Abouzgheib W, Akers S, Kass J, Bartter T. An algorithmic approach to chronic dyspnea. Respir Med. 2011 Jul;105(7):1014-21. doi: 10.1016/j.rmed.2010.12.009. Epub 2011 Jan 7. PMID: 21215608. https://pubmed-ncbi-nlm-nih-gov.wake.idm.oclc.org/21215608/ ↩