In difficult cases it is reasonable to treat more than one suspected pathology (e.g. PE, pneumonia and pulmonary oedema) at the same time while awaiting test and radiology results. 🩺⚖️

ℹ️ About

🧭 Work your way through the list in the context of the patient.
🧐 Could this be a second pathology e.g. PE in COPD or a small PTX?

🫁 Physiology

📈 Normal adult respiratory rate: 14–20 breaths/min.
⚡ Tachypnoea >30/min at rest → hypoxaemia (airway, breathing, or circulation problem).
🧪 Metabolic acidosis (e.g. DKA) → compensatory hyperventilation.
🔻 RR <10/min → respiratory fatigue or loss of central drive → may need ventilatory support.

🔍 Differentials of Breathlessness

🩺 Cause	📋 Clinical Presentation	🧪 Diagnostic Tests	💊 Treatment
❤️ Heart Failure	Exertional dyspnoea, orthopnoea, PND, fatigue, oedema, ↑JVP.	Echo, BNP, CXR (cardiomegaly, oedema), ECG, bloods.	Diuretics, ACEi/ARB, β-blockers, lifestyle; ICD/transplant if severe.
🌫️ COPD	Chronic dyspnoea, cough, wheeze, smoking Hx.	Spirometry (↓FEV1/FVC), CXR (hyperinflation), ABGs.	Smoking cessation, bronchodilators, ICS, rehab, O₂ if advanced.
🌬️ Asthma	Intermittent dyspnoea, wheeze, nocturnal cough, triggers.	Spirometry (reversible obstruction), peak flow, allergy tests.	ICS + bronchodilators, trigger avoidance.
🩸 Pulmonary Embolism (PE)	Sudden dyspnoea, pleuritic chest pain, tachypnoea, haemoptysis, ±DVT.	CTPA, D-dimer, V/Q scan, leg Doppler, ECG (S1Q3T3).	Anticoagulation, thrombolysis if massive, O₂ + fluids, embolectomy if needed.
🦠 Pneumonia	Fever, cough, purulent sputum, pleuritic pain, tachypnoea.	CXR (consolidation), sputum/blood cultures, WCC, sats.	Antibiotics, O₂, hydration, admit if severe.
🌱 ILD	Progressive dyspnoea, dry cough, crackles, clubbing.	HRCT, PFTs, biopsy if needed.	Remove cause, steroids/IS, O₂, transplant if severe.
🩸 Anaemia	Exertional dyspnoea, pallor, tachycardia, fatigue.	CBC, retics, iron/B12/folate studies.	Replace deficiency, transfuse if severe, treat cause.
💨 Pneumothorax	Sudden dyspnoea, pleuritic pain, ↓breath sounds, hyperresonant.	CXR, CT if unclear, ABG if severe.	Observe if small, aspirate/drain if large/symptomatic, surgery if recurrent.
💔 Myocardial Infarction	Chest pain, dyspnoea, radiation, sweating, nausea.	ECG, troponin, echo, angiography.	PCI/thrombolysis, antiplatelets, β-blockers, ACEi, statins.
❤️‍🩹 Congestive Heart Failure	Dyspnoea, orthopnoea, PND, oedema, ↑JVP.	Echo, CXR, BNP, ECG.	Diuretics, ACEi/ARB, β-blockers, aldosterone antagonists, lifestyle; ICD if severe.

📖 Definition

😮‍💨 Dyspnoea = difficulty breathing (usually resp or cardiac cause).
🛏️ Orthopnoea = breathlessness lying flat → classically cardiac failure.
🌙 PND = waking breathless at night, relieved by sitting upright or window-opening.

🔬 Investigations

🧪 FBC, U&E, D-dimer, glucose, troponin, CRP.
🩻 CXR → oedema, consolidation, PTX.
💉 ABG if sats <92%.
🖥️ CTA → exclude PE, may identify other pathology.

🛠️ Management

🆘 ABC, O₂, IV access + bloods.
💉 ABG if sats <92% or persistent dyspnoea.
📟 ECG + CXR; escalate to senior.

🧾 Condition-specific Management

🦠 Chest infection: Abx, O₂, physio, fluids.
💧 Pulmonary oedema: IV furosemide, GTN, treat cause.
💨 Pneumothorax: O₂, aspiration/drain.
🌬️ Asthma: Salbutamol, hydrocortisone (see acute severe protocol).
🌫️ COPD: Salbutamol, oral steroids, NIV if needed.
🩸 PE: LMWH/DOAC; thrombolysis if unstable.
🍬 DKA/metabolic acidosis: IV fluids, insulin, K⁺ replacement.

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Breathlessness