This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (61)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Melvin R. Pratter, MD; Frederick J. Curley, MD; James Dubois, RRT, RCPT; Richard S. Irwin, MD

Arch Intern Med. 1989;149(10):2277-2282.

Abstract
• To test whether, in patients with chronic dyspnea, a diagnostic approach based on objective confirmation of suspected diagnoses would be superior to one based on clinical impression alone, we prospectively studied 85 patients with a primary complaint of dyspnea seen in a pulmonary subspecialty clinic. We achieved 100% success in determining the causes of dyspnea compared with only 66% accuracy based on clinical impression alone. Four groups of disorders, asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and cardiomyopathy accounted for two thirds of the cases. Findings on the history and physical examination were too nonspecific to determine the specific diagnosis. Pulmonary function testing, including a methacholine bronchoprovocation challenge, were the most useful diagnostic tests, particularly for chronic obstructive pulmonary disease and asthma. Chest roentgenogram was most useful for interstitial lung disease, and comprehensive exercise testing for dyspnea due to psychogenic factors or deconditioning. Specific therapy was effective in reducing or eliminating dyspnea in the majority of cases. We conclude that a diagnostic approach to chronic dyspnea based on objective findings and verification, rather than clinical impression alone, will consistently lead to an accurate diagnosis and an improved therapeutic outcome.

(Arch Intern Med. 1989;149:2277-2282)

Author Affiliations
From the Division of Pulmonary and Critical Care Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicine, Camden (Drs Pratter and Dubois); and the Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School, Worcester (Drs Curley and Irwin).

Footnotes
Accepted for publication June 5,1989.

Reprint requests to Cooper Hospital/University Medical Center, 3 Cooper Plaza, Camden, NJ 08103 (Dr Pratter).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Symptoms of Respiratory Disease
Irwin
ACCP Pulmonary Med Brd Rev 2009;25:415-456.
FULL TEXT  

Discriminating Between Cardiac and Pulmonary Dysfunction in the General Population With Dyspnea by Plasma Pro-B-Type Natriuretic Peptide
Mogelvang et al.
J Am Coll Cardiol 2007;50:1694-1701.
ABSTRACT | FULL TEXT  

Methacholine Challenge Testing: Identifying Its Diagnostic Role, Testing, Coding, and Reimbursement
Birnbaum and Barreiro
Chest 2007;131:1932-1935.
ABSTRACT | FULL TEXT  

Recommendations on the use of exercise testing in clinical practice
Palange et al.
Eur Respir J 2007;29:185-209.
ABSTRACT | FULL TEXT  

Diagnosis of lung cancer in primary care: a structured review
Hamilton and Sharp
Fam Pract 2004;21:605-611.
ABSTRACT | FULL TEXT  

ATS/ACCP Statement on Cardiopulmonary Exercise Testing
Am. J. Respir. Crit. Care Med. 2003;167:211-277.
FULL TEXT  

Effects of antireflux procedures on respiratory symptoms
Greason et al.
Ann. Thorac. Surg. 2002;73:381-385.
ABSTRACT | FULL TEXT  

Streamlining Methacholine Challenge Testing
Phillips and Schreiner
Chest 2001;120:1763-1765.
FULL TEXT  

Gastro-oesophageal reflux and asthma
FIELD et al.
Thorax 2001;56:898-898.
FULL TEXT  

Unexplained Exertional Limitation . Characterization of Patients with a Mitochondrial Myopathy
FLAHERTY et al.
Am. J. Respir. Crit. Care Med. 2001;164:425-432.
ABSTRACT | FULL TEXT  

Symptom Research on Chronic Cough: A Historical Perspective
Irwin and Madison
ANN INTERN MED 2001;134:809-814.
ABSTRACT | FULL TEXT  

Increased Prevalence of Gastroesophageal Reflux Symptoms in Patients With COPD
Mokhlesi et al.
Chest 2001;119:1043-1048.
ABSTRACT | FULL TEXT  

Self-Hypnosis for Management of Chronic Dyspnea in Pediatric Patients
Anbar
Pediatrics 2001;107:21e-21.
ABSTRACT | FULL TEXT  

The Association of Asthma and Obesity: Is It Real or a Matter of Definition, Presbyterian Ministers' Salaries, and Earlobe Creases?
Wilson and Irwin
Arch Intern Med 1999;159:2513-2514.
FULL TEXT  

The Effects of Antireflux Surgery on Asthmatics With Gastroesophageal Reflux
Field et al.
Chest 1999;116:766-774.
ABSTRACT | FULL TEXT  

Gastroesophageal Reflux and Respiratory Symptoms
Field
Chest 1999;116:843-843.
FULL TEXT  

A Critical Review of the Studies of the Effects of Simulated or Real Gastroesophageal Reflux on Pulmonary Function in Asthmatic Adults
Field
Chest 1999;115:848-856.
ABSTRACT | FULL TEXT  

The Effects of Acid Perfusion of the Esophagus on Ventilation and Respiratory Sensation
FIELD et al.
Am. J. Respir. Crit. Care Med. 1998;157:1058-1062.
ABSTRACT | FULL TEXT