Symptom: Shortness of Breath

Initial Grading Reminder

CTCAE grading of shortness of breath:

Grade 1 (Mild): Shortness of breath with moderate exertion
Grade 2 (Moderate): Shortness of breath with minimal exertion; limiting instrumental ADLs
Grade 3 (Severe): Shortness of breath at rest; limiting self-care ADLs
Grade 4 (Life-threatening Consequences): urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Do you have a history of asthma or other respiratory condition?  Have you had any issues with shortness of breath in the past? When did the symptom start? Has it developed gradually or suddenly? Do you also have a cough?

Grade the symptom

Ask the patient:

When are you short of breath—at rest or only if you do something like walk or go up the stairs? If you take it easy, does it get  better? Can you lie flat?  Can you talk without becoming short of breath? Can you do your normal daily activities?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any chest pain? Any swelling in your legs? Do you have any weakness or numbness or tingling?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?