GPAtlas🧭 When to suspect
Breathlessness (dyspnoea) is the subjective, distressing awareness of difficulty breathing.
• Breathlessness is one of the commonest symptoms in primary care – around 4% of GP consultations.
• 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.
Start with the time course, the most useful early discriminator: it reshapes both the likely cause and the urgency.
Grade the functional impact with the Medical Research Council (MRC) dyspnoea scale (1 = breathless only on strenuous exercise, through to 5 = too breathless to leave the house, or breathless when dressing).
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 or 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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