Dyspnoea in Older People in the Emergency Department

  • F. Javier Martín-SánchezEmail author
  • Juan González del Castillo


Breathlessness is one of the most common complaints and is the main cause for the admission of older patients presenting to the ED. Dyspnoea is a potentially serious syndrome and can represent life-threatening emergencies [1]. In fact, dyspnoea is one of the highest mortality of all non-trauma complaints [2].


  1. 1.
    Pines JM et al (2013) National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc 61:12–17CrossRefGoogle Scholar
  2. 2.
    Safwenberg U, Terént A, Lind L (2007) The emergency department presenting complaint as predictor of in-hospital fatality. Eur J Emerg Med 14:324–331CrossRefGoogle Scholar
  3. 3.
    Ray P et al (2006) Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care 10:R82CrossRefGoogle Scholar
  4. 4.
    Delerme S et al (2008) Acute respiratory failure in the elderly: diagnosis and prognosis. Age Ageing 37:251–257CrossRefGoogle Scholar
  5. 5.
    Delerme S et al (2008) Usefulness of B natriuretic peptides and procalcitonin in emergency medicine. Biomark Insights 3:203–217CrossRefGoogle Scholar
  6. 6.
    González Del Castillo J et al (2014) Consensus guidelines for the management of community acquired pneumonia in the elderly patient. Rev Esp Geriatr Gerontol 49:279–291CrossRefGoogle Scholar
  7. 7.
    McMurray JJ et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869CrossRefGoogle Scholar
  8. 8.
    Konstantinides SV et al (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3069CrossRefGoogle Scholar
  9. 9.
    Scichilone N et al (2014) Diagnosis and management of asthma in the elderly. Eur J Intern Med 25:336–342CrossRefGoogle Scholar
  10. 10.
    Martín-Sánchez FJ et al (2013) Management of acute heart failure in Spanish emergency departments based on age. Rev Esp Cardiol 66:715–720CrossRefGoogle Scholar
  11. 11.
    Martín Sánchez FJ et al (2013) Prognostic role of NT-proBNP in emergency department in the elderly with acute heart failure. Rev Esp Geriatr Gerontol 48:155–160CrossRefGoogle Scholar
  12. 12.
    Martín-Sánchez FJ et al (2013) Key points in healthcare of frail elders in the emergency department. Med Clin (Barc) 140:24–29CrossRefGoogle Scholar
  13. 13.
    Jacob J et al (2013) Prognostic value of troponin in patients with acute heart failure attended in Spanish emergency departments: TROPICA study (TROPonin in acute heart failure). Med Clin (Barc) 140:145–151CrossRefGoogle Scholar
  14. 14.
    Righini M et al (2014) Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 311:1117–1124CrossRefGoogle Scholar
  15. 15.
    Januzzi J et al (2008) Amino-terminal pro–B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol 101:29–38CrossRefGoogle Scholar
  16. 16.
    Gaggin HK et al (2013) Biomarkers and diagnostics in heart failure. Biochim Biophys Acta 1832:2442–2450CrossRefGoogle Scholar
  17. 17.
    Cinar O et al (2012) Evaluation of mid-regional pro-atrial natriuretic peptide, procalcitonin, and mid-regional pro-adrenomedullin for the diagnosis and risk stratification of dyspneic ED patients. Am J Emerg Med 30:1915–1920CrossRefGoogle Scholar
  18. 18.
    Maisel A et al (2012) Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (biomarkers in acute heart failure) trial. Eur J Heart Fail 14:278–286CrossRefGoogle Scholar
  19. 19.
    Singer AJ et al (2009) The incremental benefit of a shortness of-breath biomarker panel in emergency department patients with dyspnoea. Acad Emerg Med 16:488–494CrossRefGoogle Scholar
  20. 20.
    Klæstrup E et al (2011) Reference intervals and age and gender dependency for arterial blood gases and electrolytes in adults. Clin Chem Lab Med 49:1495–1500CrossRefGoogle Scholar
  21. 21.
    Prosen G et al (2011) Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnoea in prehospital emergency setting. Crit Care 15:450CrossRefGoogle Scholar
  22. 22.
    Lichtenstein DA et al (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134:117–125CrossRefGoogle Scholar
  23. 23.
    Kajimoto K et al (2012) Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnoea in the emergency setting. Cardiovasc Ultrasound 10:49CrossRefGoogle Scholar
  24. 24.
    Rogers IS et al (2011) Usefulness of comprehensive cardiothoracic computed tomography in the evaluation of acute undifferentiated chest discomfort in the emergency department (CAPTURE). Am J Cardiol 107:643–650CrossRefGoogle Scholar
  25. 25.
    Mariani J et al (2011) Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail 17:850–859CrossRefGoogle Scholar
  26. 26.
    Lightowler JV et al (2003) Noninvasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and metaanalysis. BMJ 326:185CrossRefGoogle Scholar
  27. 27.
    Holzer-Richling N et al (2011) Randomized placebo controlled trial of furosemide on subjective perception of dyspnoea in patients with pulmonary oedema because of hypertensive crisis. Eur J Clin Investig 41:627–634CrossRefGoogle Scholar
  28. 28.
    Incalzi RA et al (2014) Chronic obstructive pulmonary disease in the elderly. Eur J Intern Med 25:320–328CrossRefGoogle Scholar
  29. 29.
    Hawkins NM et al (2010) Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme. Eur J Heart Fail 12:557–565CrossRefGoogle Scholar
  30. 30.
    Maak CA et al (2011) Should acute treatment with inhaled Beta agonists be withheld from patients with Dyspnoea who may have heart failure? J Emerg Med 40:135–145CrossRefGoogle Scholar
  31. 31.
    Miravitlles M et al (2014) Spanish guideline for COPD (GesEPOC). Update 2014. Arch Bronconeumol 50(Suppl 1):1–16PubMedGoogle Scholar
  32. 32.
    Yahav D et al (2013) Time to first antibiotic dose for patients hospitalised with community-acquired pneumonia. Int J Antimicrob Agents 41:410–413CrossRefGoogle Scholar
  33. 33.
    Geerts WH et al (2008) Prevention of venous thromboembolism: American College of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6 Suppl):381S–453SCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • F. Javier Martín-Sánchez
    • 1
    Email author
  • Juan González del Castillo
    • 1
  1. 1.Emergency DepartmentHospital Clínico San CarlosMadridSpain

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