If the person does not have an indication for emergency admission:

• Look for clinical features of:
• Acute asthma, especially in people with wheeze or cough that is worse at night, or upon exercise or exposure to allergens.
• An acute exacerbation of chronic obstructive pulmonary disease (COPD), especially in people older than 35 years of age who smoke (or who have smoked), particularly if they have wheeze and a new or worsening cough.
• Pneumonia, especially in people with a cough and at least one other symptom of sputum, wheeze, fever, or pleuritic pain.
• Lung/lobar collapse, especially in people with a history of cancer with lymph node involvement, an inhaled foreign body, or debility causing retained airway secretions.
• Pleural effusion, especially in people with: heart, liver, or renal failure; cancer; tuberculosis; or pleural infection.
• Psychogenic breathlessness, especially in people who have no clinical features of a physical cause for breathlessness.
• Arrange investigations to confirm a suspected cause, or to identify the cause when the cause is uncertain.
• Manage the underlying cause of breathlessness. For people with:
• Acute asthma — see the CKS topic on Asthma.
• Acute exacerbation of COPD — see the CKS topic on Chronic obstructive pulmonary disease.
• Bronchiectasis — see the CKS topic on Bronchiectasis.
• Community-acquired pneumonia — see the CKS topic on Chest infections - adult.
• Lung/lobar collapse — refer the person to a respiratory specialist for investigation of the underlying cause.
• Pleural effusion — refer (or admit) the person, for drainage of the effusion and investigation of the underlying cause.
• Psychogenic breathlessness:
• Explain that the person's symptoms are due to anxiety and hyperventilation.
• Advise the person to try to control their breathing rate (by counting breaths in and out gently), slowing it down.
• Manage any persistent symptoms of hyperventilation, using a bag to re-breathe expired air.
• Consider management of any underlying anxiety disorder.
• Consider referral to a respiratory physiotherapist, so the person can learn methods of controlling breathlessness.
• For people with acute breathlessness that remains of uncertain cause, reassess for risk factors and clinical features of pulmonary embolism. Arrange urgent referral for further investigations if pulmonary embolism is suspected.