• The terms dyspnoea and breathlessness are commonly used interchangeably. However, breathlessness is physically apparent in a person, whereas dyspnoea is the sensation of difficulty in breathing.
• Like pain, dyspnoea is subjective and involves the perception of breathlessness and the person's reaction to it. Anxiety is often a major component of dyspnoea.

• Ask about:
• Features of the dyspnoea (e.g. severity, timing, onset, and precipitating and exacerbating factors).
• Associated physical symptoms.
• Associated psychological symptoms (e.g. anxiety).
• Drug history (e.g. nonsteroidal anti-inflammatory drugs, beta-blockers, chemotherapy).
• Quality of life.
• Role of carers.

In depth

• 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).
• Looking for features of a panic attack or hyperventilation.
• If appropriate, observe the person walking a set distance or carrying out a set task.

In depth

• Investigations should be guided by the:
• Clinical assessment.
• Stage of disease and person's prognosis.
• Risk-to-benefit ratio of the investigation.
• Wishes of the person and their family.
• The most useful investigations to consider in all people with non-acute dyspnoea in a palliative care situation in primary care include:
• Chest radiography (to assess lung disease and heart failure).
• Spirometry (to assess possible undiagnosed chronic obstructive pulmonary disease, however, spirometry can be difficult for people with cancer because of pain).
• Full blood count (to exclude anaemia).
• Pulse oximetry, if available (to assess hypoxia).
• Electrocardiography (to exclude arrhythmia).

In depth