CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Palliative cancer care - dyspnoea - Management
What should I look for on examination?
- Perform an appropriate examination for the stage of the person's illness, to attempt to determine the cause of the dyspnoea.
- This should include a general examination, examination of the person's respiratory and cardiovascular systems, assessment of the effectiveness of the person's breathing (e.g. depth of breathing and expectoration of secretions), and looking for features of a panic attack or hyperventilation.
- If appropriate, observe the person walking a set distance or carrying out a set task.
Clarification / Additional information
- General examination for dyspnoea may reveal pallor (suggestive of anaemia) or plethora and engorged veins of the neck and chest area (suggestive of superior vena cava obstruction) [Munro, 1995].
- Determine whether the person is breathing effectively (e.g. taking deep breaths, expectorating secretions).
- Chest examination may reveal findings suggestive of a cause of dyspnoea (see Table 1). Note: atypical presentations may occur.
Table 1. Typical findings associated with dyspnoea and possible diagnoses.
| Chest expansion | Percussion note | Breath sounds | Added sounds |
|---|
Pleural effusion | Reduced on affected side | Stony dull on affected side | Absent or decreased | None |
Consolidation | Reduced on affected side | Dull on affected side | Bronchial | Crepitations |
Collapse with bronchial obstruction | Reduced on affected side | Dull on affected side | Absent or decreased | None |
Upper airway obstruction | Reduced | No difference between sides of the chest | Depends on the severity of the obstruction | Stridor |
Pneumothorax | Reduced | Hyper-resonant on side of pneumothorax | Absent or decreased | None |
COPD/asthma | May be symmetrically decreased | No difference between sides of the chest | May be normal, but silent chest in severe asthma | Wheeze |
Panic | Normal | Normal | Normal | None |
Acidosis* | Normal | Normal | Normal | None |
Heart failure | Normal, or may be signs of pleural effusion | Normal, or may be signs of pleural effusion | Normal, or may be signs of pleural effusion | Basal crepitations |
Respiratory muscle weakness† | Reduced | Normal | Normal | None |
COPD = chronic obstructive pulmonary disease. * The breathing pattern in a person with acidosis is typically deep and rapid. † In people with respiratory muscle weakness, a paradoxical breathing pattern may be observed. |
|
Basis for recommendation
© NHS Institute for Innovation and Improvement