Shortness of breath, or dyspnea, is a painless but uncomfortable awareness of breathing that is inappropriate to the level of exertion. Thoroughly assess this telltale symptom of cardiac and pulmonary disease.

Ask,"Have you had any difficulty breathing?" Find out if the symptom occurs at rest or with exertion, and how much exertion produces onset. Because of variations in age, body weight, and physical fitness, there is no absolute scale for quantifying shortness of breath. Instead, make every effort to determine its severity based on the patient's daily activities. How many steps or flights of stairs can the patient climb before pausing for breath? What about carrying bags of groceries, vacuuming, or making the bed? Has shortness of breath altered the patient's lifestyle and daily activities? How? Carefully elicit the timing and setting, any associated symptoms, and relieving or aggravating factors.

Most patients relate shortness of breath to their level of activity. Anxious patients present a different picture. They may describe difficulty taking a deep enough breath, a smothering sensation with inability to get enough air, and paresthesias, which are sensations of tingling or "pins and needles" around the lips or in the extremities.

Wheezes are musical respiratory sounds that may be audible to the patient and to others.

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