It’s autumn and winter again, and as in previous years, there are a lot of patients who visit the hospital emergency department with shortness of breath, chest tightness, shortness of breath, and other discomforts. Shortness of breath, chest tightness and shortness of breath is a subjective experience, that is, the feeling of struggling to breathe or not having enough air, which is uniformly called dyspnea in medical symptomology. In medical books, dyspnea refers to the patient’s feeling of insufficient air and labored breathing; objective manifestation of respiratory movement exertion, heavy nasal flapping, open mouth and shrugging shoulders, even cyanosis, respiratory assist muscle activity, or accompanied by abnormalities in respiratory frequency, depth (such as fast and shallow, slow and deep breathing) and rhythm. For patients, what department should they visit for respiratory distress? The vast majority of patients will first consult a respiratory department. So, is dyspnea caused by respiratory diseases? Here, we present a case recently admitted to our neurology department. He had a history of hypertension and smoked for 30 years, 40 cigarettes per day. He was diagnosed with chronic obstructive pulmonary disease (COPD) in an outside hospital, and his symptoms did not improve after several hospitalizations, and his dyspnea was still obvious. The respiratory specialist reviewed the patient’s pulmonary function and blood gas results from outside the hospital. Although there was mild obstructive ventilation disorder in the pulmonary function, it was not enough to explain the patient’s severe dyspnea symptoms and type II respiratory failure. After careful history taking, the patient was also found to have weakness of the extremities, and muscle atrophy was evident on examination! So, after explaining the patient’s condition to his family, this experienced respiratory specialist referred him to the neurologist, who looked at him and the result was immediate admission to the hospital. The patient’s electromyography, nerve conduction velocity, and cerebrospinal fluid tests were completed after admission, and the patient was finally considered to have immune-mediated polyneuropathy, which improved with glucocorticoid and neurotropic treatment. Immune-mediated polyneuropathy is a group of peripheral neuropathies due to immune response, including chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barre syndrome (GBS), POEMS syndrome, multifocal motor neuropathy (MMN), monoclonal prolactinopathy (MGUS) with peripheral neuropathy, paraneoplastic peripheral neuropathy, and vasculitis peripheral neuropathy, etc. The main clinical manifestations are muscle weakness, myasthenia, sensory abnormalities and other symptoms of peripheral nerve damage, but also the brain nerve can be involved in choking and coughing, distorted corners of the mouth, double vision, etc. A small number of patients may develop respiratory muscle weakness, manifesting as dyspnea, or even respiratory failure. Other systemic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, multiple myeloma, etc., may also be combined. In terms of ancillary tests, electromyography and nerve conduction velocity may be abnormal to varying degrees in about 75% of patients; protein-cell separation may be present in cerebrospinal fluid examination by lumbar puncture, and immune index abnormalities may also be present in combined connective tissue diseases. Although there is no protein-cell separation in the cerebrospinal fluid and the patient improved after hormone treatment, it is still considered as immune-mediated peripheral neuropathy, and further examination is needed for the combination of other immune diseases. Dyspnea is a common clinical symptom and can be seen in respiratory, cardiovascular, neuropsychiatric and other systemic diseases. In the neurological system, brain diseases (such as craniocerebral trauma, cerebrovascular disease, meningitis, etc.), cervical medullary diseases (such as myelitis, spinal cord infarction, spinal cord tumors, etc.), peripheral neuropathies (Greenbarr syndrome is the most common), muscle diseases (myositis, dermatomyositis, metabolic muscle disease, etc.), neuromuscular junction diseases (myasthenia gravis, Lambert-Eaton syndrome, etc.), and The onset of dyspnea can be slow or rapid, and the duration of the disease varies, but it is often accompanied by other manifestations such as muscle weakness, atrophy, muscle pain, numbness of hands and feet, choking on water, distorted corners of the mouth, double vision, and skin rash. Therefore, when patients have unexplained dyspnea, they should be alert to neurological diseases, ask about neurological symptoms, conduct neurological examination, and improve electrophysiological examination such as electromyography and neuroelectrogram, and if necessary, perform lumbar puncture to obtain cerebrospinal fluid for laboratory tests, as well as neuromuscular biopsy to clarify the diagnosis and guide treatment.