Original Article: Chronic Dyspnea: Diagnosis and Evaluation

Issue Date: May 1, 2020

See additional reader comments at: https://www.aafp.org/afp/2020/0501/p542.html

To the Editor: As a family physician who had to retire from practice six years ago because of chronic hypoxia, I read with special interest the article on chronic dyspnea by Drs. Budhwar and Syed. When I became ill with cough, fatigue, and shortness of breath, my physician performed most of the workup the author describes. The diagnosis unfortunately remained unclear for many months until I checked my oxygen saturation while walking for three minutes in my office. I was shocked that my pulse oximetry reading was 78% with room air. It was later determined that I have an intrapulmonary shunt.

Although the article recommends checking oxygen saturation, I would humbly suggest that it also be evaluated with exertion if readings at rest are within normal limits, as mine had always been. Since my diagnosis, I have wondered how many patients I might have been able to correctly diagnose as hypoxic by checking oxygen saturations with exertion.

Knowing the difference that oxygen therapy made in my life inspired this suggestion.

Editor's Note: This letter was sent to the authors of “Chronic Dyspnea: Diagnosis and Evaluation,” who declined to reply.