Shortness of breath or dyspnoea is the uncomfortable awareness of breathing. It could result from variety of disease either anxiety, cardiac causes or lung causes.
1) Question need to ask to this patient
A) Is patient experience SOB before? (Exclude prolong cause of SOB causes by COPD, Asthma, Heart disease)
B) Any chest pain? (To exclude chest or cardiac chest pain)
C) Any history of Ischemic heart disease (to rule out cardiac failure.)
D) Any history of asthma, allergic, hay fever (to exclude bronchial asthma)
E) Any fever? (To rule out infection this could indicate lung infection, acute exacerbation of COPD, Pericarditis)
F) Precipating factor (trauma, recumbent position, paroxymal nocturnal dyspnoea, cat, dust)
G) Relieving factor (sitting up for cardia origin, B2 agonist in asthma)
H) Any association factor (haemoptysis, wheezing)
2) Investigation to be performed
a) Spirometry (to make a diagnosis of COPD-decrease in both FEV1 and FEV1/FVC)
b) Bronchodilator reversibility testing (to rule out diagnosis of asthma with typical history)
c) Chest X-ray (excludes alternative diagnosis of pulmonary TB and identify comorbidities such as cardiac failure
d) ABG (look any sign of respiratory failure secondary to COPD)
e) Blood C&S and Sputum culture (to identify any pathogen)
3) the most probable diagnosis is acute exercebation of COPD)
Rationale
A) COPD should be considered in any patient who has dyspnoea, chronic cough, sputum production and/or any history of exposure to risk factor
B) Worldwide, the most common encountered risk factor is cigarette smoking
c) Onset in mid life compared with childhood in asthma
Reference: GOLD Pocket Guide to COPD Diagnosis, Management, And Prevention, “A Guide for Health Care Professionals", updated 2008.
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