Why the orthopnea and nocturnal paroxysmal dyspnea?

Dyspnea, a term used to describe a multitude of symptoms related to 'an uncomfortable sensation of breathing,' is a common symptom that is very disturbing to patients. To further complicate matters, this sensation has a wide range of causes, has no accurate objective measurement, and is described and experienced differently - patients with the same degree of disease can perceive their symptoms as a mild annoyance or an acute crisis. Given so many pulmonary and cardiac possibilities - what is the best way to pinpoint the cause of dyspnea? To facilitate your own work-up of patients with this symptom, The Journal of Respiratory Diseases has asked two pulmonologists to present a series of cases from their own practices in which dyspnea presented a challenge. In this series of 'dyspnea clinics,' Drs Boyars and Bidani present the history, physical examination, initial diagnosis and treatment, follow-up, and outcome of each case. They provide step-by-step assessment that highlights important diagnostic clues and illustrates how objective tests are used to refine and confirm the diagnosis.