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

• Look for clinical features of:
• Chronic heart failure, especially if the person has a history of ischaemic or valvular heart disease, hypertension, or the onset of chronic cardiac arrhythmias (such as atrial fibrillation).
• Asthma, especially in people with wheeze or cough that is worse at night, or upon exercise or exposure to allergens.
• 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.
• Bronchiectasis, especially in non-smokers with chronic progressive breathlessness that is associated with either a chronic productive cough or recurrent chest infections.
• Interstitial lung disease, especially in people with a history of exposure to asbestos, dust (such as coal dust), birds, hay, or mushrooms.
• Pleural effusion, especially in people with: heart, liver, or renal failure; cancer; tuberculosis; or pleural infection.
• Abdominal splinting secondary to obesity or ascites.
• Anaemia.
• Arrange investigations to confirm the cause of breathlessness.
• Manage the underlying cause of chronic breathlessness. For people with:
• Chronic heart failure — see the CKS topic on Heart failure - chronic.
• Asthma — see the CKS topic on Asthma.
• COPD — see the CKS topic on Chronic obstructive pulmonary disease.
• Bronchiectasis — see the CKS topic on Bronchiectasis.
• Restrictive lung disease — refer the person to a respiratory specialist for assessment and management of the cause.
• Pleural effusion — refer (or admit) the person, for drainage and investigations of the underlying cause of the effusion.
• Anaemia — see the CKS topics on:
• Anaemia - B12 and folate deficiency.
• Anaemia - iron deficiency.
• Diaphragmatic splinting that is secondary to:
• Obesity — see the CKS topic on Obesity.
• Ascites — refer the person to an appropriate specialist for management of the underlying cause.
• For people with chronic breathlessness that remains of uncertain cause, reassess for risk factors and clinical features of pulmonary embolism:
• If pulmonary embolism is suspected, arrange urgent referral.
• If pulmonary embolism seems unlikely, arrange routine referral.