Breathlessness in adults: IPCRG desktop helper for primary care physicians

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Published Jun 21, 2026
https://doi.org/10.62438/tunismed.v104i06.6803
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Vol. 104 No. 06 (2026): Tunis Med Jun 2026

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Khouloud Kchaou
Department of Physiology and Functional Explorations, Abderrahmen Mami Hospital, Ariana, Faculty of Medicine of Tunis,University of Tunis El Manar,Tunisia
https://orcid.org/0000-0001-7116-1336
Gillian Doe
Division of Respiratory Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
https://orcid.org/0000-0003-4782-5811
Ann Hutchinson
Wolfson Palliative Care Research Centre, University of Hull
https://orcid.org/0000-0001-9480-9764
Jacob Sandberg
Department of Health, Blekinge Institute of Technology, Karlskrona, Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden.
https://orcid.org/0000-0003-1863-2033
Anthony Sunjaya
Chronic Respiratory Disease Research Group, School of Population Health, UNSW Sydney, Respiratory Program, The George Institute for Global Health, Australia
https://orcid.org/0000-0003-2257-4374
Helmi Ben Saad
Research Laboratory LR12SP09 'Heart Failure' , Department of Physiology and Functional Explorations, Farhat Hached University Hospital, Sousse, Faculty of Medicine 'Ibn el Jazzar' of Sousse, University of Sousse, Tunisia
https://orcid.org/0000-0002-7477-2965
Siân Williams
International Primary Care Respiratory Group (IPCRG), London, UK
https://orcid.org/0000-0002-0527-2254

Abstract

Background: Breathlessness is common, anxiety-provoking, and challenging to clarify in primary care. When it persists beyond four weeks, it markedly
impairs quality of life, functional capacity, and prognosis, and can trigger urgent consultations if underlying causes are not recognized and managed. Chronic breathlessness is frequently multifactorial, combining cardiopulmonary disease with obesity, deconditioning, breathing pattern disorders, anxiety, anemia, and post-coronavirus disease 2019 conditions.
Objective: This technical sheet aimed to provide primary care physicians with a structured, pragmatic, person-centered approach to the assessment and
management of chronic breathlessness.
Content: This technical sheet emphasized early identification of acute/urgent presentations of breathlessness in adults (including pulse oximetry when available), systematic evaluation (history, examination, accessible investigations such as spirometry, chest radiography, electrocardiogram, complete blood count, N-terminal pro–B-type natriuretic peptide, and screening for anxiety/depression and physical activity level), and staged diagnostic reasoning that may require several visits while safely managing uncertainty. Management includes optimizing treatment of underlying conditions according to national guidance and early introduction of evidence-based non-pharmacological strategies. The breathing–thinking–functioning model is proposed to structure symptom control: correcting maladaptive breathing patterns, addressing fear and distress, and tackling deconditioning through appropriate rehabilitation and activity support.
Conclusion: A structured primary-care pathway combined with early non-pharmacological interventions can improve consultations, support self-
management, and enhance outcomes in adults with chronic breathlessness.

Keywords:

Activity Tolerance, Anxiety Disorders, Biopsychosocial Model, Chronic Dyspnea, Multimorbidity, Pulmonary Rehabilitation, Self-Management, Structured Diagnostic Strategy

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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