TY - JOUR T1 - The challenge of breathlessness in the detection of pulmonary hypertension JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 1 LP - 3 DO - 10.1183/09059180.00008511 VL - 21 IS - 123 AU - F. Blasi Y1 - 2012/03/01 UR - http://err.ersjournals.com/content/21/123/1.abstract N2 - Acute or chronic shortness of breath (dyspnoea) is a common reason for patients to consult their primary care physicians. However, appropriate diagnosis and deciding whether or when to refer the patient to specialist care can be a challenge. Dyspnoea has been defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity” [1]; however, patients may use a variety of descriptions for their symptoms, such as “my chest feels tight” or “I cannot get enough air” [2]. A patient's perception of their symptoms will also vary depending on their context, such as whether they occur on physical exertion or at rest, and on whether symptoms have come on acutely or developed gradually over time. Individuals with chronic dyspnoea are often limited in their activities, with resulting impairment in physical functioning and quality of life [1].Dyspnoea can be a symptom of a variety of underlying conditions. These include cardiac conditions (such as myocardial infarction, arrhythmias or valvular disease), pulmonary conditions (such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary embolism or lung malignancy), or a range of other causes (such as panic attacks, thyroid disease, anaemia or obesity) [1–3]. In many cases, dyspnoea may be due to multifactorial causes [4]. For some patients, the probable cause of dyspnoea may be obvious, such as exacerbation of known asthma, COPD or heart failure, but for others, particularly younger previously healthy individuals, a thorough diagnostic evaluation to establish the underlying cause is required.A full clinical history and physical examination provide the first clues to the diagnosis of dyspnoea. For example, intermittent breathlessness with triggering factors may suggest asthma, while a history of heavy tobacco smoking and a productive cough may suggest COPD … ER -