Breathlessness and cough in the acute setting

The symptom of breathlessness is well recognized as part of the presentation of a wide range of medical conditions. It can be a manifestation of a life-threatening emergency. In acute medical settings, the priority is to quickly recognize patients who are critically unwell and require emergency treatment. For them, rapid initial assessment and immediate treatment are essential. Once symptoms have stabilized, or in less acute settings, a more thorough assessment is required. Cough is a common respiratory symptom, often part of a symptom complex and frequently troublesome for patients. It is important to recognize concerning associated features to prompt further investigation. In late 2019, severe acute respiratory syndrome coronavirus 2 infection emerged from a zoonotic source, resulting in many cases of infection, hospitalization and death, and has since spread in a pandemic across every continent. Even 5 years later, it remains a concern. A substantial percentage of patients with coronavirus disease (COVID-19) develop an acute respiratory illness requiring hospital care. Cough and acute breathlessness are two of the most prevalent symptoms in this infection; all such patients presenting to acute settings should currently be assumed to have COVID-19 and immediately tested with a viral swab from the upper airway to guide management.