Resp History

Question 1

COPD

Answer 1

Productive cough
Wheeze on auscultation

Question 2

Previous respiratory problems

Answer 2

Pneumonia - can lead to bronchiectasis or pulmonary fibrosis
Tuberculosis - can reactivate
Severe measles or whooping cough - can lead to bronchiectasis
Asthma

Question 3

Have you had any recent surgery?

Answer 3

Dental surgery - aspiration of purulent material or fragments of tooth
Abdominal, pelvic, orthopaedic surgery - risk factors for DVT and subsequently PE

Question 4

Other past medical history

Answer 4

Cardiac disease - pulmonary oedema (specifically ask about angina, orthopnoea, paroxysmal nocturnal dyspnoea)

Immunocompromised - predispose to atypical infections

Question 5

Drug history and allergies

Answer 5

Inhalers
Steroids
Antibiotics
ACE inhibitors (may cause cough)
Amiodarone (pulmonary fibrosis)
Beta blockers (may worsen airway obstruction)
NSAIDs
Oxygen therapy
Atopic asthma worsened by allergies

Question 6

Social history

Answer 6

Occupation (industrial hazards e.g. dust, asbestos)
Smoking (pack years: 1 pack = 20, x number of years)
Pets (hypersensitivity reactions)
Overseas travel
Living conditions e.g. damp
Alcohol
Exercise, ADLs, independence

Question 7

Family history

Answer 7

Infections may be transmitted between family members
Genetic predisposition to allergic conditions (atopic asthma)
A1AT deficiency - genetic cause of emphysema

Question 8

PC: Breathlessness

Answer 8

How are you normally? (Acute, Chronic, Acute on Chronic?)
Onset, timing, duration, variability, diurnal variation
Exacerbating factors e.g. allergic triggers, exertion, cold air
Relieving factors e.g. rest, medication
Associated symptom e.g. cough, sputum, haemoptysis, pain, wheeze, night sweats, weight loss, oedema
Severity e.g. at rest? only on exertion? Limiting ADLs?

Question 9

PC: Cough

Answer 9

Onset
Timing
Duration (less than 2 hours = acute, more than 2 hours = chronic)
Variation e.g. recent change in a chronic cough
Diurnal variation
Productive?

Question 10

PC: Sputum

Answer 10

Onset, timing, duration, variation, diurnal variation
Colour e.g. rusty = pneumococcal pneumonia, frothy pink = pulmonary oedema
Consistency e.g. viscous (fluid), mucous, purulent, frothy
Quantity e.g. teaspoon, cupful etc.
Odour (fetid = bronchiectasis or lung abscess)

Question 11

PC: Haemoptysis

Answer 11

Origin - differentiate haemoptysis from haematemesis (was it coughed or vomited up?)
Onset, timing, duration, variation
Quantity
Colour (fresh blood or dark altered blood)
Consistency (liquid, clots, mixed with sputum)
Sputum

Chest pain
Recent trauma to chest or elsewhere?
Recent/current DVT?
Weight loss, fever, night sweats?
Breathlessness
Bleeding or bruising elsewhere?

Question 12

Pulmonary embolism