# Shortness of Breath (Dyspnoea) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - cardiovascular.pdf, Furosemide monograph (chapter PDF p162) · Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) · Suha F, Modi P, Sharma S. Dyspnea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - cardiovascular.pdf, Furosemide monograph (chapter PDF p162) - Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) ## Treatment metadata - Salbutamol — oral.inhalation - Furosemide — oral.solid ## Complete treatment card ```text SHORTNESS OF BREATH (DYSPNOEA) Sources: Egyptian National Drug Formulary - cardiovascular.pdf, Furosemide monograph (chapter PDF p162) · Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) · Suha F, Modi P, Sharma S. Dyspnea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - Sudden breathlessness points to an asthma flare, pneumonia, anaphylaxis, a lung clot, a collapsed lung, a heart attack or heart failure [breathlessness · collapse] - Breathlessness building over weeks or months leans towards COPD, lung fibrosis, motor neurone disease or a failing heart [breathlessness] - Ask about lying flat, waking at night breathless, wheeze, cough, chest pain, fever and swelling [chest pain · cough · fever · wheeze] - Record fever, cough, blood in the sputum, chest pain, night-time breathlessness and how much sputum [breathlessness · chest pain · cough · coughing up blood · fever · sputum] - Ask what led up to it: missed heart failure tablets, diet slips, a new allergen or a recent cold - Recent surgery, injury or a spell of being immobile raises the chance of a clot - Ask whether this is new or a repeat, and about known asthma, coronary disease, heart failure or previous clot - Ask whether a breathing tube has ever been needed before, as that predicts a severe attack - A family history of clotting disorders raises the chance of a lung clot - Ask about tobacco, vaping and recreational drugs - Blaming anxiety for sudden breathlessness is only safe once everything physical has been excluded [anxiety · breathlessness] SIGNS - what you find (12) - Distress shows as fast breathing, accessory muscle use, flaring nostrils, blue lips, low oxygen or confusion [chest recession · confusion · cyanosis · tachypnoea] - Urgent: pulse above 120, breathing above 30 a minute, or oxygen saturation below 90 percent [hypoxia] - Also urgent: stridor, breath sounds louder on one side, widespread crackles, sweating, an unstable rhythm or an inability to finish a sentence [crackles · stridor · sweating] - Chest examination may find asymmetry, a dull percussion note, wheeze, crackles or quiet breath sounds [crackles · wheeze] - Feel the neck for a shifted windpipe, which signals a tension pneumothorax - Absent or quiet breath sounds down one side mean air or blood in that chest - Feel for crackling under the skin or a flail segment; percuss for hyperresonance or dullness - Stridor on breathing in means blockage above the vocal cords; on breathing out it means below them [stridor] - Raised neck veins, a displaced apex beat, a murmur or a gallop point to the heart [heart murmur · raised JVP] - A third heart sound means high left-sided filling pressures; a fourth means a stiff ventricle - A loud pulmonary second sound suggests pulmonary hypertension; muffled sounds suggest fluid round the heart [hypertension] - Finger clubbing, blue discolouration, swelling or wasted muscle suggest long-standing low oxygen or systemic illness [cyanosis · finger clubbing] TESTS (12) - Most acute presentations get a chest x-ray, an ECG, a full blood count and electrolytes including bicarbonate - The oximeter can read falsely high with carbon monoxide, methaemoglobin, a high HbA1c or dark skin - It reads falsely low with severe anaemia, bright ambient light, nail varnish or abnormal haemoglobins - Bedside ultrasound assesses heart function, fluid round the heart, a collapsed lung, pleural fluid, right heart strain and leg clot - On lung ultrasound, A-lines with sliding fit COPD or asthma while bilateral B-lines mean fluid in the lung - Chest CT is not for everyone; it earns its place after trauma or when the x-ray is unclear - A neck x-ray can show retropharyngeal abscess, epiglottitis or a swallowed metal object - Arterial blood gas is only needed when the oximeter reading cannot be trusted - Troponin alongside the ECG looks for heart muscle damage; a first normal value settles nothing, so repeat it - Brain natriuretic peptide helps establish acute heart failure - A D-dimer of 500 ng/mL or higher calls for imaging, preferably CT pulmonary angiography - A peak flow meter separates lung from heart causes and shows how tight the airways are IF NOT THIS - what else fits (12) - Sudden onset: anaphylaxis, a lung clot, a collapsed lung, fluid round the heart or a heart attack - Slow onset: COPD, interstitial lung disease, motor neurone disease or heart dysfunction - Anaemia, an abnormal heart rhythm, ascites and aspiration all belong on the list - Anxiety is a listed cause but remains a diagnosis of exclusion - Bronchiectasis and bronchiolitis are the chronic airway causes to consider - A restricted chest or abdomen counts: spinal curvature, marked obesity, late pregnancy or a ventral hernia - Early pregnancy alone can cause it, through progesterone - An inhaled foreign body or a goitre can obstruct the airway - Paradoxical vocal fold motion produces an inducible laryngeal obstruction - Simple deconditioning and diaphragm paralysis are both on the list - Neuromuscular disease, phrenic nerve problems and polymyositis are listed causes - Kidney failure, a stiff cardiomyopathy, thyroid disease and venous clot all belong here Source StatPearls "Dyspnea" - disease-level clinical article Status traced to the source above 1. SALBUTAMOL [1st line] Adult Inhaler: one inhalation (100 mcg) or two inhalations, up to 4 times a day for persistent symptoms; maximum 8 inhalations/day, not more often than every 4 hours. - As needed for symptomatic relief of bronchospasm; reassess if requiring frequent use. Peds Different inhaler and nebuliser doses apply in children under 12; not reproduced here as this condition entry is being used for adult breathlessness. Source Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) Why Salbutamol is the standard first-line reliever for breathlessness caused by bronchospasm in asthma or COPD, which are among the common causes of this symptom in primary care. Caution Inhaled, not swallowed: the dose is the metered-dose inhaler's 100 mcg per actuation. Only appropriate when breathlessness is due to reversible airway obstruction (asthma/COPD) - not to breathlessness from heart failure, anaemia, or other causes. Sudden severe breathlessness with chest pain, stridor, inability to speak in full sentences, or low oxygen saturation/cyanosis are emergencies needing immediate referral, not routine inhaler treatment. Frequent need for the reliever inhaler signals poorly controlled disease and needs step- up therapy/referral. Can cause tremor, tachycardia, and hypokalaemia, especially at high or nebulised doses. RED FLAG - Sudden severe breathlessness with chest pain may be pulmonary embolism or heart attack, stridor or inability to speak in full sentences means severe airway obstruction, and breathlessness with leg swelling or worse when lying flat may be heart failure. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP SALBOVENT RESPIRATOR 5MG/ML SOLN. 20 ML ALEXANDRIA 17.50 EGP BRONCHOLIN S 0.5% RESPIRATOR SOLN. 30 ML EIPICO 37.00 EGP ALVEOTRACK 5 MG/ML INH. SOLN. 30 ML MDI PHARMA 49.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VENTOLIN DISKUS 200MCG/DOSE ACCUHALER GLAXO SMITHKLINE 86.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation 2. FUROSEMIDE [2nd line] Adult 20-50 mg by mouth as a single initial dose in a patient not already on a loop diuretic, then titrate as needed to the desired effect. - As directed; ongoing/repeated dosing guided by response (weight, oedema, breathlessness) once volume overload is confirmed. Peds 2 mg/kg single initial dose; if ineffective, may increase in 6-8 hours by 1-2 mg/kg increments to maximum 6 mg/kg/dose Source Egyptian National Drug Formulary - cardiovascular.pdf, Furosemide monograph (chapter PDF p162) Why Furosemide is the standard diuretic for breathlessness caused by fluid overload from heart failure, one of the important causes of this symptom that a GP treats directly. Caution Taken by mouth, not injected: the dose text reads '20-50 mg by mouth'. Only appropriate when breathlessness is due to fluid overload (e.g. heart failure) - confirm the diagnosis (e.g. leg swelling, orthopnoea) before starting. Monitor renal function and electrolytes (especially potassium and sodium), particularly with higher or repeated doses. Breathlessness with chest pain, stridor, inability to speak in sentences, or low oxygen saturation are emergencies needing urgent referral rather than routine outpatient diuretic dosing. Caution in dehydration and in combination with other nephrotoxic drugs or antihypertensives (risk of hypotension). Contraindicated in anuria, hepatic disease, severe electrolyte depletion, and hypersensitivity to sulfonamides. Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) LAFUREX 20MG 20 TAB. AMOUN 8.50 EGP (0.42/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) FURORETIC 500 MG 20 TABS. DEBEIKY > VET... 93.00 EGP (4.65/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)