How to take a respiratory history Flashcards
What are the main structures involved in respiratory disease?
Breathing tubes (Obstructive)
Lung parenchyma (Restrictive)
Chest wall (Restrictive)
Pulmonary circulation
Pleura
What are the main disease types in the respiratory history?
Inflammatory
Neoplastic
Infective
Vascular
Why is occupation important in respiratory disease?
Many respiratory occupations are associated with lung disease
Baker, metal worker
Asbestos – joiner, steel works, shipworks, navy
Laboratory work, pet stores
etc…
Helps you connect with the patient and helps you understand them better.
Questions to ask about occupation?
Were you ever exposed to industrial dusts or irritants?
Were you ever exposed to cigarette smoke?
When presenting the complaint what kind of questions do you ask?
Open vs closed questions
…”of what do you complain?”
…What can I help you with here today?
…What brings you to see me today?
I say: “Your doctor tells me you have a number of problems: what is the biggest problem for you?”
Fit and well as a child?
Premature?
Whooping cough/pneumonia – bronchiectasis
“bronchitic” – Asthma?
Sat out in games
Went to open-air school
Questions to ask when patient is suffering from breathlessness?
Onset
Duration
Intermittent?
Relieving/exacerbating factors?
Diurnal variation?
Associated factors
- Chest pain, Palpitations
What is the MRC dyspnoea scale?
Grade 1 – only SOB on severe exercise
Grade 2 - Short of breath when hurrying on a level or when walking up a slight hill
Grade 3 -Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
Grade 4 - Stops for breath after walking 100 yards, or after a few minutes on level ground
Grade 5 - Too breathless to leave the house, or breathless when dressing/undressing
Further things to consider for breathlessness?
Progression?
Stable?
Progressive? Up and Down? Improving?
Speed of progression?
Exacerbations?
Relationship to other symptoms?
What do we consider and questions we ask when patient is wheezing?
Onset, duration, alleviating or exacerbating factors
Inspiration/expiration?
Inspiratory wheeze is ‘Stridor’
Diurnal variation?
What to consider when a patient has a cough?
Onset, duration, alleviating or exacerbating factors
Productive or dry?
Sputum? Nature? Volume?
Haemoptysis?
What to ask when patient has chest pain?
Site, onset, nature, duration, alleviating or exacerbating factors
Association with breathlessness?
Association with cough?
What are some other respiratory symptoms a patient might suffer from?
Tiredness/Malaise
Fever/night sweats
Weight loss
Collapses, blackouts or falls
How do we check past medical history?
Check with patient and GP letter/Integrated clinical portal
Other medical problems (diagnosed and undiagnosed)
‘Cured’ cancers?
How do we check for a drug history with the patient?
Ask patient – clues to adherence?
Then check…
-GP letter
-Repeat prescription list
-Summary care record
Anything over the counter /Herbal/traditional
Implanted: contraceptives, other hormones etc
What are some common drugs with respiratory side effects? 1
Clopidogrel<Ticagrelor – unexplained breathelessness
Aspirin/NSAIDs – asthma
ACE inhibitors - cough
Betablockers – wheeze
Amiodarone – pulmonary toxicity
Methotrexate – pneumonitis>fibrosis
