Shortness of Breath Sends Patients to the ED

Shortness of breath is one of the most common symptoms that send a patient to the emergency department (ED). However, several related health concerns-including asthma, pericarditis, and pneumonia-are treatable within the primary care office.

“Imagine you can’t breathe and you can’t get your medications. Shortness of breath is scary. Then the emergency room is an appropriate place to go,” Tracy LeGros, MD, PhD, Associate Professor, Louisiana State University Interim Hospital (former Charity Hospital program), New Orleans, told a packed auditorium at the American Academy of Emergency Medicine’s 20th Annual Scientific Assembly in New York.

There are a large number of health concerns related to a patient who comes to a primary care physician with complaints of shortness of breath. These concerns include congestive heart failure, myocardial infarction, a blood clot in the lungs that turns into a pulmonary embolism, pneumonia, rib fracture, pericarditis, pleuritis, lung hemorrhage, asthma, chronic obstructive pulmonary disease, and emphysema.

“To evaluate these potential causes, do a thorough physical exam, get an electrocardiogram and chest x-ray, and treat any symptoms,” says Dr LeGros. “Then reassess the patient’s response. More extensive treatment and studies will likely be needed as the most probable etiologies present themselves.”

For the concerns that are not simple to treat within the primary care office, the patient should be sent to the ED for evaluation or directly admitted, as needed, Dr LeGros says.

Many patients with asthma end up in the ED. The prevalence of asthma is increasing in patients already at risk, including those of low socioeconomic status and those who live alone. The risk factors to look for among patients with asthma include respiratory infections that the patient can’t handle.

Contrary to popular belief, the underinsured and the poor do not make up the majority of ED visits, according to Dr LeGros. “These patients do present, and often,” she says. “However, most patients present because they are not responding to home therapy and feel their condition is emergent.”

Other causes are related to difficulties in obtaining timely primary care appointments and running out of medications, Dr LeGros says. These patients present to primary care offices because they cannot follow up with their doctor, because it may take many days or several weeks to be seen.

Primary care physicians are adept at ferreting out serious versus less serious causes of shortness of breath, Dr LeGros notes. She encourages them to call the ED and let the ED staff know who they are sending and why. This also would be progressive to lessen challenges to having refills filled if the patient cannot be seen that day.

Medication for asthma is life-saving, Dr LeGros points out, and although inhalers usually are provided by most pharmacists-who recognize the vital need of these patients-other medications, such as prednisone, usually are not provided without authorization.