Questionnaire/history: Distressing sensation or awareness of difficulty in breathing (DIB) (breathlessness (dyspnoea))? Onset? Pattern and symptom variability? MRC dyspnoea score? - Grade 0: not troubled by breathlessness except on strenuous exertion? - Grade 1: short of breath when hurrying on level ground or walking up a slight incline? - Grade 2: walks slower than contemporaries because of breathlessness, or has to stop for breath when walking at own pace? - Grade 3: stops for breath after walking about 100 metres or stops after a few minutes of walking on level ground? - Grade 4: too breathless to leave the house or breathless on dressing or undressing? Increased respiratory rate (shortness of breath (SOB))? - SOB at rest? Chest pain? - Cardiac pain? - Pleuritic pain? Cough? - Coughing up blood? - Yellowish or green phlegm? Associated symptoms? - Feeling cold and clammy with pale or mottled skin? - Little or no urine output (last time of urination)? - New confusion? - Becoming difficult to rouse? - Cannot stand due to dizziness/faint? - Collapse or fainting (syncope)? - COVID-19 symptoms? - Onset? - COVID-19 PCR test? Unable to cope at home? Past medical history? Current medication? Drug allergies? Advance Care Plan/Plan on CMC? Examination: Consciousness (AVPU score)? BP? Pulse? SpO2? RR? Can complete sentence? After 40 step test or 1 minute sit-to-stand test: - BP? - Pulse? - SpO2? - RR? - Can complete sentence? - Desaturation (>= 3% from resting values)? Stridor? Wheezing? PF < 50% of predicted? Temperature? Chest? Heart? Abdomen? CRT? Peripheral oedema? NEWS? Diagnosis: For differential diagnosis see NICE CKS Management: According to cause Reference(s): Clinical Effectiveness (CE) Southwark: Breathlessness NICE CKS: Breathlessness Primary Care and Community Respiratory Resource Pack, Version 7