ABSTRACT
The beginning of the symptoms of dyspnea can be dated with precision by some patients with acute illnesses or with rapidly changing diseases. For many patients with chronic respiratory diseases, such as emphysema or idiopathic pulmonary fibrosis, the onset of symptoms was insidious, and they cannot recall exactly when impairment began. An episode of unusually intense exercise or activity may unmask symptoms for many patients with gradually progressive disease. Swimming in the summertime, a mountain hike, deer hunting, household relocation, or a major housecleaning may uncover symptoms hidden by a more sedentary lifestyle. Patients often have difficulty estimating whether their dyspnea is stable or changing. Helping them to recall specific, recurrent activities and comparing performance may focus these symptoms.
