The patient at the centre of this review additionally complained of breathlessness. Berliner et al (2016) identified that 1 in 4 of patients in the community presented with breathlessness and it is the third most common reason for calls to 999 (Woollard and Greaves, 2004). The American Thoracic Society defines breathlessness as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity” (Parshall et al, 2012, pg438). It is important to recognise the relevance of subjectivity. This makes an accurate diagnosis a significant challenge as patients will describe the same symptom in different ways. The presence of dyspnoea alone is a predictor of increased mortality, making it essential for the clinician to interrogate all possible causations (Berliner et al, 2016). Dyspnoea is also considered a non-specific symptom however it is also the primary symptom of cardiovascular or neuromuscular dysfunction (Nishino, 2016). DiagnosisPro (2018) listed 516 causes of dyspnoea highlighting a clear need for this symptom to be assessed in a considered manner.
While not in the remit of an APP to decide the treatment regime for this patient it represents an excellent opportunity to signpost likely diagnoses to those involved in the patient’s continuing care. Additionally there is an opportunity to prevent hospital attendance thereby reducing pressure on A&E departments while simultaneously reducing the risk from in-hospital illness, estimated to be three times more likely for patients in this age group