It is important to assess the severity of breathlessness in terms of daily activities. If these are impaired, the precise limiting factor should be identified. For example, the exercise tolerance of an elderly patient may be more limited by intermittent claudication, angina pectoris or osteoarthritic hips than by breathlessness attributable to chronic bronchitis. Though grading systems exist to assess cardiac and respiratory disabilities (see Table 4.11), simple questions about daily activity provide an effective functional assessment of the severity of dyspnoea (see Table 4.12).

TABLE 4.11 heart failure

New York Heart Association classification: severity of

Grade I

No dyspnoea at rest or on moderate exertion

Grade II

Dyspnoea on moderate exertion No symptoms at rest or on mild exertion

Grade III

Dyspnoea on mild exertion but minimal at rest

Grads IV

Significant dyspnoea at rest and often bed bound Severe dyspnoea on minimal exertion

Note: Patients with major heart disease may have no: or only minor, symptoms, while patients with only minor heart disease may have major symptoms especially if they are anaemic, pregnant or anxious,

TABLE 4.12 Functional assessment of breath lessness

TABLE 4.12 Functional assessment of breath lessness

• Is sleep disturbed by breathlessness?

• Does breathlessness occur at rest?

• Does breathlessness interfere with normal conversation?

• Does dressing or washing produce breathlessness?

• How far can the patient walk on the fiat without stopping?

• How many stairs can the patient climb without stopping?

• What activities are avoided because of breathlessness?

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