Diagnosis and investigations

Breathlessness is first noticed on vigorous

exercise and the initial response is to avoid

circumstances which lead to its production.

As FEV1 falls to 60% predicted patients

commonly have difficulty maintaining the

same walking speed as their contemporaries

and may experience breathlessness during

exacerbations. With worsening pulmonary

function breathlessness comes to dominate the

clinical presentation and is the most feared

symptom by patients. The following features

are usually present:

• Breathlessness is present throughout the

day and may be associated with

intermittent chest tightness, which must

be distinguished from angina;

• Similar tasks will produce similar degrees

of breathlessness on different days;

• The patient’s appreciation of wheezing

varies considerably and sudden attacks of

wheezing are uncommon;

• Bronchodilator drugs appear to improve

the rate of resolution of exertional

breathlessness but these effects are slower

than in bronchial asthma.