Clinical case review

A 65-year-old woman developing dyspnoea on exercise

Peter Frith



With a careful history and simple examination, a family physician can diagnose this patient’s problem and initiate early treatment and referral.

Article Extract

How should this older patient with possible mild asthma and exertional dyspnoea be investigated and managed?

Case scenario

A 65-year-old woman taking regular fluticasone and salmeterol for mild asthma reported a change in her exercise tolerance. Over the past four months, she had noticed that she became quite breathless after walking up more than about 16 to 20 steps. The breathlessness occurred after a lag of 30 to 60 seconds and persisted for a few minutes, even if she was then walking slowly on level ground. She attributed it to her asthma, but should her cardiovascular system be checked?