Last updated: September 6, 2022
Dyspnea, or shortness of breath, is a subjective feeling of breathing discomfort. It is a commonly reported symptom in acute care and outpatient settings. Causes of dyspnea include pulmonary (e.g., pneumonia, asthma exacerbation), cardiac (e.g., acute coronary syndrome, congestive heart failure), toxic-metabolic (e.g., metabolic acidosis, medication use), upper airway (e.g., epiglottitis, foreign body aspiration), psychological, and neuromuscular pathologies. On initial presentation, it is important to immediately evaluate the patient for any urgent or life-threatening causes of dyspnea using patient history, physical examination, and diagnostic testing. Once immediately life-threatening causes have been ruled out, a more detailed patient history should be obtained and further testing performed to narrow the differential diagnosis.
See also “Respiratory failure and arrest.”
Assume that all dyspnea is life-threatening until proven otherwise and perform the following steps concurrently, not sequentially.
Prioritize rapid identification and treatment of critical causes of dyspnea over advanced testing to obtain a definitive diagnosis. 
When evaluating a patient with dyspnea, always consider infection control and the need for PPE and patient isolation.
Red flags in dyspnea
The presence of any of these red flags suggests that dyspnea is the result of a serious pathologic process.
Anticipate rapid clinical deterioration in patients with red flag features.
Immediately life-threatening causes of dyspnea
See also “Rapidly reversible causes of respiratory failure.”
The severity of symptoms reported by the patient may not correlate with disease severity. Remain vigilant for life-threatening causes of dyspnea. 
Upper airway causes
Toxic-metabolic and other causes
Overview of causes of dyspnea by speed of onset
Cardiopulmonary disease may be mistaken for panic attacks, as symptoms and pathogenesis overlap. Consider organic causes before attributing dyspnea to anxiety. 
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