Interview

• 1). Ask the patient about the details of his shortness of breath. Define the symptom; find out how long he has suffered from it. The main symptom variables to identify include time of onset, duration, location, quality, severity and radiation.
  
  
• 2). Establish a history of the symptom. Talk to the patient about other times he has felt short of breath. This discussion may help you uncover a pattern in symptom presentation; for instance, if the patient has difficulty breathing with physical exertion on a regular basis, it may indicate a cardiac or respiratory problem.
  
  
• 3). Discuss the patient's pre-existing conditions. This involves obtaining a detailed medical history from the patient. It is critical to understand his history of disease, surgeries, hospitalizations, as any one of these factors may result in breathing difficulty. Discuss the patient's medications at this point, as some drugs are known to produce side effects, including shortness of breath. Talk to the patient about drug use, especially tobacco smoking.
  
  

Physical Examination

• 1). Perform a through lung exam, which is paramount when assessing shortness of breath. Using your stethoscope, listen to all lung fields for any abnormal sounds of crackling, wheezing or decreased breath sounds.
  
  
• 2). Perform a full cardiac exam, listening to all six areas of the heart with both the bell and the diaphragm of your stethoscope. This portion of the physical exam may reveal an underlying cardiac condition, such as a murmur, that is caused by an incompetent heart valve.
  
  
• 3). Measure the patient's respiratory rate in order to quantify the shortness of breath. Normal adult respiratory rates range from 12 to 18 breaths per minute; the degree of deviation from this range is a helpful indicator of the severity of the patient's breathing difficulty.