GPAtlas🧭 When to suspect
Breathlessness (dyspnoea) is the subjective, distressing awareness of difficulty breathing. It is one of the commonest symptoms in primary care – around 4% of GP consultations – and in roughly two-thirds of cases the cause is cardiorespiratory. In adults over 40, the five conditions to think of first are COPD, heart failure, obesity/deconditioning, anaemia and anxiety.
The single most useful early discriminator is the time course, because it reshapes both the likely cause and the urgency. Grade the functional impact with the MRC dyspnoea scale (1 = breathless only on strenuous exercise, through to 5 = too breathless to leave the house, or breathless when dressing).
The key clinical skill is twofold: exclude the immediately life-threatening cause first, then work systematically towards a specific diagnosis – breathlessness is a symptom, not a diagnosis, and its treatment depends entirely on the underlying cause.
| Time course | Causes to prioritise |
|---|---|
| Acute (minutes) | Pneumothorax (especially tension), pulmonary embolism, acute asthma, anaphylaxis, acute coronary syndrome, acute pulmonary oedema, inhaled foreign body. |
| Subacute (hours–days) | Pneumonia / lower respiratory tract infection, exacerbation of asthma or COPD, decompensating heart failure, pleural effusion, COVID-19. |
| Chronic (weeks–months) | COPD, chronic heart failure, anaemia, obesity / deconditioning, interstitial lung disease, lung cancer, anxiety / hyperventilation, chronic thromboembolic disease. |
Source: NICE NG106 · NICE NG115 · NHS England breathlessness pathway
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