Breathlessness in the emergency care setting.

PURPOSE OF REVIEW: Breathlessness is one of the most common reasons for presentation at the emergency department (ED). The present review summarizes work published from 2017, which focuses on the symptom of breathlessness in its own right rather than as a signpost to diagnosis in relation to presentation to the ED.

RECENT FINDINGS: Seven relevant papers are included in the present review. Five describe the epidemiology of breathlessness presentation showing: a prevalence of approximately 5% all ED presentations, a high likelihood of hospital admission especially for those with heart failure, breathlessness as a predictor of re-presentation. A sixth study described self-management strategies for breathlessness crises used by expert patients in successfully avoiding presentations to the ED. The seventh study reported the validation of the shorter dyspnea severity scale for use in the ED using a mixture of symptom report and clinical observation measures.

SUMMARY: Breathlessness is a common presenting feature in the ED and carries clinical outcome significance irrespective of the causative disease. Routine enquiry is needed to identify, assess, and manage breathlessness alongside interventions to stabilize underlying reversible pathologies. Presentation to the ED because of breathlessness should trigger community-based, supported self-management for future episodes of breathlessness crises.