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• Dyspnea (difficulty breathing) can indicate a number of health problems including pulmonary disorders, congestive heart failure (CHF), coronary heart disease (CHD), myocardial ischemia, and myocardial infarction (MI).
• Clients who have chronic obstructive pulmonary disease (COPD) may describe their dyspnea as not being able to "breathe or take a deep breath".
• Anxious clients may describe their dyspnea as feeling like they are suffocating or may have tingling in the lips due to a decrease in carbon dioxide level.
• Gradual onset of dyspnea is usually indicative of lung changes such as emphysema; sudden onset is associated with viral or bacterial infections.
• Severity


  They may have continuous coughing ("smoker's cough") with lots of sputum, shortness of breath with everyday activities, and wheezing (American Lung Association, 2012). Common symptoms of asthma are wheezing, frequent cough with or without mucous, shortness of breath, and chest tightness (American Lung Association, 2012). Dyspnea with exercise or heavy activities is normal if the dyspnea subsides with resting from the activity. Dyspnea will occur with typical nonstrenuous activities (such as walking one block or climbing two stairs) of daily living in clients with lung disease.
• Older adults may experience dyspnea with certain activities related to aging changes of the lungs (loss of elasticity, fewer functional capillaries, and loss of lung resiliency).
• Dyspnea can occur with stress and anxiety.
• Associated symptoms provide clues to the underlying problem. Certain associated symptoms suggest problems in other body systems. For example, edema or angina that occurs with dyspnea may indicate a cardiovascular problem. Orthopnea (difficulty breathing when lying supine) may be associated with heart failure. Paroxysmal nocturnal dyspnea (severe dyspnea that awakens the person from sleep) also may be associated with heart failure. Changes in sleep patterns may cause the client to feel fatigued during the day.
• Sleep apnea (periods of breathing cessation during sleep) may be the source of snoring and gasping sounds. In general, sleep apnea diminishes the quality of sleep, which may account for fatigue or excessive tiredness, depression, irritability, loss of memory, lack of energy, and a risk for automobile and workplace accidents.
• Immediately assess any reports of chest pain further to determine if it is due to cardiac ischemia, which is a medical emergency requiring immediate assessment and intervention.
• Pain-sensitive nerve endings are located in the parietal pleura, thoracic muscles, and tracheobronchial tree, but not in the lungs. Thus chest pain associated with a pulmonary origin may be a late sign of pulmonary disease.
• Chest pain related to pleuritis may be absent in older clients because of age-related alterations in pain perception.
• Continuous coughs are usually associated with acute infections, whereas those occurring only early in the morning are often associated with chronic bronchial inflammation or smoking. Coughs late in the evening may be the result of exposure to irritants during the day. Coughs occurring at night are often related to postnasal drip or sinusitis.
• The ability to cough effectively may be decreased in the older client because of weaker muscles and increased rigidity of the thoracic wall.
• Nonproductive coughs are often associated with upper respiratory irritations and early congestive heart failure (CHF).
• White or mucoid sputum is often seen with common colds, viral infections, or bronchitis. Yellow or green sputum is often associated with bacterial infections. Blood in the sputum (hemoptysis) is seen with more serious respiratory conditions. Rust-colored sputum is associated with tuberculosis or pneumococcal pneumonia. Pink, frothy sputum may be indicative of pulmonary edema. An increase in the amount of sputum is often seen in an increase in exposure to irritants, chronic bronchitis, and pulmonary abscess ("Sputum color," 2006-2011). Clients with excessive, tenacious secretions may need instruction on controlled coughing and measures to reduce viscosity of secretions.
• Wheezing indicates narrowing of the airways due to spasm or obstruction. Wheezing is associated with CHF, asthma (reactive airway disease), or excessive secretions.
• Studies have shown that up to 75% of clients with asthma have gastroesophageal reflux disease (GERD) or are more susceptible to GERD (Cleveland Clinic, 2008).
• A history of respiratory disease increases the risk for a recurrence. In addition, some respiratory diseases may imitate other disorders. For example, asthma symptoms may mimic symptoms commonly associated with emphysema or heart failure.
• Previous surgeries may alter the appearance of the thorax and cause changes in respiratory sounds. Trauma to the thorax can result in lung tissue changes.
• Many allergic responses are manifested with respiratory symptoms such as dyspnea, cough, or hoarseness. Clients may need education on controlling the amount of allergens in their environment.
• Consider all medications when determining if respiratory problems could be attributed to adverse reactions. Certain medications, for example, beta-adrenergic antagonists (beta blockers) such as atenolol (Tenormin) or metoprolol (Lopressor) and angiotensin-converting enzyme (ACE) inhibitors such as enalapril (Vasotec) or lisinopril (Zestril), are associated with the side effect of persistent cough (The Asthma Center, 2011). These medications are contraindicated with some respiratory problems such as asthma. If the client is using oxygen or other respiratory therapy at home, it is important to evaluate knowledge of proper use and precautions as well as the client's ability to afford the therapy.
• Information on previous chest x-rays, TB skin tests, influenza immunizations, and the like is useful for comparison with current findings, and provides insight on self-care practices and possible teaching needs.
• Travel to high-risk areas such as mainland China; Hong Kong; Hanoi, Vietnam; Singapore; or Toronto, Canada may have exposed the client to SARS (severe acute respiratory syndrome).
• The risk for lung cancer is thought to be partially based on genetics. A history of certain respiratory diseases (asthma, emphysema) in a family may increase the risk for development of the disease (CDC, 2011). Exposure to viral or bacterial respiratory infections in the home increases the risk for development of these conditions.
• Second-hand smoke puts clients at risk for COPD (including emphysema and chronic bronchitis) or lung cancer later in life (CDC, 2011).
• Some pulmonary disorders, such as asthma, tend to run in families.
• Poor nutritional status (both weight loss and obesity) is frequently seen in clients with COPD and is a predictor of mortality (Kelly, 2007).
• Smoking is linked to a number of respiratory conditions, including lung cancer. The number of years a person has smoked and the number of cigarettes per day influence the risk for developing smoking-related respiratory problems. Information on smoking behavior and previous efforts to quit may be helpful later in identifying measures to assist with smoking cessation.
• Exposure to certain environmental inhalants can result in an increased incidence of certain respiratory conditions. Environmental irritants commonly associated with occupations include coal dust, insecticides, paint, pollution, asbestos fibers, and the like. For example, inhaling dust contaminated with Histoplasma capsulatum may cause histoplasmosis, a systemic fungal disease. This disease is common in
• Smoking is linked to a number of respiratory conditions, including lung cancer
• The number of years a person has smoked and the number of cigarettes per day influence the risk for developing smoking-related respiratory problems
• Information on smoking behavior and previous efforts to quit may be helpful later in identifying measures to assist with smoking cessation
• Exposure to certain environmental inhalants can result in an increased incidence of certain respiratory conditions
• Environmental irritants commonly associated with occupations include coal dust, insecticides, paint, pollution, asbestos fibers, and the like
• Inhaling dust contaminated with Histoplasma capsulatum may cause histoplasmosis, a systemic fungal disease
• Histoplasmosis is common in the rural midwestern United States
• Second-hand smoke is another irritant that can seriously affect a person's respiratory health
• Respiratory problems can negatively affect a person's ability to perform the usual ADLs
• Shortness of breath can be a manifestation of stress