ABSTRACT
Many patients with acute breathlessness are given oral steroids, but this is often not indicated. Although oral steroids can rapidly reduce airway inflammation in acute asthma exacerbations, a well-controlled asthmatic ideally should never reach the point of exacerbating. In bronchiectasis, patients develop dilated airways, usually following an infective insult earlier in life or as a manifestation of an underlying immunodeficiency state. Breathlessness can be due to respiratory or cardiac disease, and so all breathless patients should be screened with a serum NT-proBNP. If elevated, an echocardiogram is usually performed, which may in turn show evidence of pulmonary hypertension. Asbestos was widely used in the 1950s–1960s as an insulating material in many industries, leaving a large cohort of individuals who have a history of working within an asbestos-rich environment. Asbestos exposure can cause many respiratory issues later in life, including lung cancer, mesothelioma, diffuse pleural thickening, benign pleural effusions, asbestosis and pleural plaque disease.
