Shortness of breath is a common patient concern that can represent dyspnea, orthopnea, or PND. Dyspnea is an uncomfortable awareness of breathing that is inappropriate to a given level of exertion. This complaint is common in patients with cardiac or pulmonary problems.

Orthopnea is dyspnea that occurs when the patient is supine and improves when the patient sits up. Classically, it is quantified by the number of pillows the patient uses for sleeping, or by the fact that the patient needs to sleep sitting up. Make sure that the patient is using extra pillows or sleeping upright due to shortness of breath and not other causes.

PND describes episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air. There may be associated wheezing and coughing. The episode usually subsides but may recur at about the same time on subsequent nights.

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