Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9691310.26442/20751753.2019.1.190279Review ArticleManagement of a patient with dyspnea on an outpatient admissionVertkinArkadii L.D. Sci. (Med.), Prof., Head of Department of Therapy, Clinical Pharmacology and Emergency Medicinekafedrakf@mail.ruTopolyanskyAleksei V.D. Sci. (Med.), Assistant Professor at Department of Therapy, Clinical Pharmacology and Emergency Medicine; Head of Cardiology Department-KnorringGerman Yu.Cand. Sci. (Med.), Assistant Professor at Department of Therapy, Clinical Pharmacology and Emergency Medicine-ShamuilovaMarina M.D. Sci. (Med.), Prof. at Department of Therapy, Clinical Pharmacology and Emergency Medicine-A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian FederationS.I.Spasokukotsky City Clinical Hospital of the Department of Health of Moscow150120192119810419012022Copyright © 2019, Consilium Medicum2019Background. Management of patients with dyspnea syndrome remains complicated in terms of diagnostics and treatment in outpatient conditions. Aim. To present a summary of contemporary view of diagnostic search directions, differential diagnosis in dyspnea syndrome as well as of the main points of therapeutic approach with the focus on diuretics use. Materials and methods. We systematized materials from Russian and foreign publications (PubMed, eLIBRARY and other) for the past 2-15 years as well as present clinical recommendations and guidelines, and provided citations and beliefs of Russian medicine classics about the discussed phenomena in order to write this review. Results. The diagnostic approach in dyspnea syndrome is based in analysis of anamnestic, objective, laboratory and instrumental data and requires from the medical practitioner a scrupulous analytic approach to identify the cause of the disorder and to manage it prescribing pathogenic therapy on time. Diuretics use remains one of the basic approaches to pathogenic therapy. Conclusion. Management of a patient with dyspnea in outpatient conditions remains challenging. It is an interdisciplinary issue that is not completely worked out in terms of diagnostics and treatment and requires fundamental knowledge and awareness of modern approaches to diagnostics and treatment of major disorders characterized with dyspnea syndrome.heart failuredyspnearespiratory failurediureticstorasemideсердечная недостаточностьодышкадыхательная недостаточностьдиуретикиторасемид[Основы клинической диагностики для врачей и студентов. Под ред. А.М.Левина, Д.Д.Плетнева. М.-Л.: Госиздат, 1928.][Мясников А.Л. Основы диагностики и частной патологии (пропедевтика) внутренних болезней. М.: Медгиз, 1952.][Беленков Ю.Н., Мареев В.Ю. Лечение сердечной недостаточности в XXI веке: достижения, вопросы и уроки доказательной медицины. Кардиология. 2008; 2: 6-16.][Кутузова А.Э. Комплексная реабилитация больных хронической сердечной недостаточностью. Доктор.Ру. 2013; 6 (84): 10-5.][Верткин А.Л., Тополянский А.В., Петровская Т.П. Пациент с одышкой на амбулаторном приеме. Амбулаторный прием. 2016; 1 (4): 13-20.][Верткин А.Л., Ховасова Н.О., Наумов А.В. Коморбидный пациент - герой нашего времени. Доктор.Ру. Спецвып.: Амбулаторный прием. 2014; 5 (9): 31-6.][Мареев В.Ю., Фомин И.В., Агеев Ф.Т. и др. Клинические рекомендации ОССН - РКО - РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018; 58 (6S): 8-158.][Некрасов А.А., Мельниченко О.В., Фролов А.Г. и др. Определение и роль NT-proBNP при хронической обструктивной болезни легких и при ее сочетании с ишемической болезнью сердца. Военно-мед. журн. 2011; 332 (3): 78-81.][Преображенский Д.В., Некрасова Н.И., Хосева Е.Н. и др. Торасемид - эффективный петлевой диуретик для длительной терапии артериальной гипертонии. Кардиология. 2011; 4: 67-73.][Cosín J, Díez J, TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 2002; 4 (4): 507-13.][Dunn C.J, Fittion A, Broglen R.N. Torasemide. Review of its pharmacology and therapeutic use. Drugs 1995; 49 (1): 121-42.][Yamato M, Sasaki T, Honda K et al. Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure. Circ J 2003; 67 (5): 384-90.][Верткин А.Л., Тополянский А.В., Кнорринг Г.Ю., Абдуллаева А.У. Одышка у пациента на амбулаторном приеме. РМЖ. 2017; 4: 290-5.]