Breathlesness

Question 1

COF RESUS

Answer 1

Clarify- what do you mean by bretahlessness
Onset- how long has this been going on for
Frequency- are you always breathless or only sometime
Relieving factors- does anything help you get your breath back eg. Resting
Exacerbating factors- anything make it worse eg. Lying flat
Sleeping Upright- how many pillows at night/ do you wake up gasping for air
Severity- how far can you walk before the breathlessness stops you/ how many stairs can you manage in one go

Question 2

Systems review

Answer 2

General- FAWRJNLBBD

Cardiorespiratory- chest pain, palpitations, cough, sputum, haemoptysis, leg swelling, wheeze, anxiety (chest pain and anxiety)

Question 3

ACS

Answer 3

Acute onset 
Associated with nausea and sweating 
Central chest pain 
CV risk factors
In elderly may be silent and only present with the breathlessness

Question 4

Heart failure

Answer 4

sob, orthopnoea, PND
Pink frothy sputum
Peripheral oedema
Cardiac history

Question 5

Pneumonia

Answer 5

Acute SOB, cough, sputum
Systemic symptoms eg. Fever
Likely background of respiratory disease eg, COPD
chest pain

Question 6

Asthma

Answer 6

Intermittent wheeze, diurnal variation, nocturnal cough, exacerbating factors eg. Pets
Atopic background eg, eczema or hay fever
job/occupational

Question 7

COPD

Answer 7

Chronic SOB, significant smoking history, chronic sputum production
Progressive condition/ increasing disability
Can also develop acute infective and non infective exacerbations that can present similar to an asthma exacerbation

Question 8

Pneumothorax

Answer 8

Sudden onset pleuritic chest pain

Risk factors

Question 9

PE

Answer 9

Pleuritic chest pain
Haemoptysis
Risk factors
Signs of a DVT

Question 10

Pulmonary fibrosis

Answer 10

Progressive SOB over a long period
dry cough
Environmental and occupational risk factors are seen eg. Farmers lung

Question 11

Others

Answer 11

Anaemia 
Pleural effusion 
Bronchiectasis 
Aortic stenosis
Mesothlioma

Question 12

Lung malignancy

Answer 12

Weight loss and haemoptysis
Significant smoking history
Progressive breathlessness, hoarse voice, dysphagia, wheezing, stridor, recurrent chest infections, chest discomfort
Paraneoplastic syndromes- cushings or SIADH (usually related to small cell lung cancer)

Question 13

Patients perspective

Answer 13

Affecting daily life
Ideas what may be causing it
Concerns about what’s causing it
Expectations

Question 14

PMH

Answer 14

Ask about asthma COPD heart disease

Question 15

DH

Answer 15

OTC
Oxygen at home
Nebulisers etc.

Question 16

FH

Answer 16

IHD asthma

Question 17

SH

Answer 17

Smoke
Job- occupational exposure eg, asbestos, birds, fumes, coal miners and farmers lungs etc.
How are you managing at home eg. Do you have stairs?

Question 18

Acute pulmonary oedema

Answer 18

Severe breathlessness often precipitated by ACS, arrhythmia or deterioration of renal function
Orthopnea, PND, and cough (frothy pink sputum)

Question 19

Investigations

Answer 19

Full cardioresp examination and bedside observations 
ECG
Bloods- FBC UE Trop BNP 
ABG
CXR
Spirometry testing 
Peak flow tests/ CTPA if needed etc.

Question 20

COVID19

Answer 20

Ask about vaccines, sense of taste and smell etc.

May see COVID pneumonitis on an XRay