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Am Fam Physician. 2021;103(1):8

Original Article: Chronic Dyspnea: Diagnosis and Evaluation

Issue Date: May 1, 2020

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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.

Email letter submissions to Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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