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The ensuing chronic obstructive pulmonary pathology ultimately culminates in irreversible airflow obstruction, potentially escalating to chronic respiratory failure and mortality (205, 206)

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A deficiency can lead to a type of anemia that causes pale skin and shortness of breath

8 However, lack of familiarity with the condition, its nonspecific symptoms indirectly related to orthostatic intolerance and the overlap of symptoms with those of similar conditions often result in unnecessary referrals, excessive testing and a delay in diagnosis, as concern about missing an alternative diagnosis often adds to the diagnostic challenge