Diagnostic approach to chronic dyspnoea in adults.

Autor:	Ferry OR; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia., Huang YC; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia., Masel PJ; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia., Hamilton M; Brisbane North Primary Health Network, Brisbane, Australia., Fong KM; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia., Bowman RV; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia., McKenzie SC; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Cardiology Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia., Yang IA; Thoracic Medicine Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2019 Oct; Vol. 11 (Suppl 17), pp. S2117-S2128.
DOI:	10.21037/jtd.2019.10.53
Abstrakt:	Chronic dyspnoea, or breathlessness for more than four weeks duration, is a common symptom in adults presenting to primary and tertiary care. It often presents a diagnostic challenge due to the wide spectrum of underlying disease, which is multifactorial in approximately one third of cases. Challenges in diagnosis include an often non-diagnostic clinical assessment, difficulty in selecting the most appropriate investigations and correct speciality referral for further diagnostic assessment. In patients presenting with chronic dyspnoea, history and physical examination are often non-specific with key findings more useful as negative predictive factors. There is a broad range of simple to specialised investigations that may be utilised in the diagnostic workup. Several diagnostic algorithms incorporating different tiers of investigations have been tested in studies of chronic dyspnoea patients but there is currently very limited data that test a diagnostic algorithm against standard clinical care. In this review we propose a diagnostic pathway with primary, secondary and tertiary level investigations for patients with chronic dyspnoea. This pathway is based on the combination of previously tested diagnostic algorithms in the literature, to assist clinicians in their diagnostic workup of chronic dyspnoea patients. Further research is needed to further evaluate diagnostic algorithms in this setting and to test this diagnostic pathway in clinical practice. Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare. (2019 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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