Orthopnoea and Paroxysmal Nocturnal Dyspnoea

CLINICAL DIAGNOSTIC MANUAL

Orthopnoea and paroxysmal nocturnal dyspnoea (PND) are respiratory symptoms indicating breathing difficulties associated with body positions and specific times of the day. Orthopnoea refers to difficulty breathing while lying down, causing the patient to sleep sitting up or semi-upright to alleviate symptoms.

Paroxysmal nocturnal dyspnoea, on the other hand, is the sudden onset of breathlessness that occurs at night, waking the patient with a sensation of suffocation that generally improves upon sitting or standing.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Pulmonary oedema	Severe dyspnoea, orthopnoea, productive cough with pink, frothy sputum	Chest X-ray, echocardiogram, elevated BNP or NT-proBNP
COPD	Chronic dyspnoea, cough with sputum, history of smoking	Spirometry, chest X-ray
Asthma	Episodes of wheezing, coughing, dyspnoea that worsen at night or when lying down	Spirometry, bronchoprovocation test, clinical history
Cardiac arrhythmia	Palpitations, dizziness, syncope, paroxysmal nocturnal dyspnoea	Electrocardiogram (ECG), Holter monitoring, echocardiogram