Respiratory Histories

Question 1

What PC might you see in a resp hx?

Answer 1

SOB
Cough
Sputum
Haemoptysis
Wheeze
Chest pain
Systemic sx (fatigue / fever / wt loss)

Question 2

What questions do you want to ask about a BREATHLESSNESS (SOB) hx?

Answer 2

How is the patient normally? (Is this acute / chronic / acute on chronic?)

Onset / Timing / Duration / Variability / Diurnal variation

E /R factors
-> (E) = Allergic triggers / Exertion / Cold air
-> (R) = Rest / Medication

Asso sx
-> Cough / Sputum / Haemoptysis / Pain /
Wheeze / Night sweats / Wt loss / Oedema

Severity
-> At rest? Only on exertion? Limiting ADLs?

Question 3

What questions do you want to ask about a COUGH hx?

Answer 3

Onset / Timing / Duration
< 2 months = acute
> 2 months = chronic

Variation
-> Recent change in a chronic cough?
-> diurnal variation.

Productive / unproductive?

Question 4

What questions do you want to ask about a SPUTUM hx?

Answer 4

Onset / Timing / Duration / Variation / Diurnal variation

Colour
-> Rusty sputum = ?pneumococcal pneumonia;
-> Frothy pink may = ?pulmonary oedema
-> Any haemoptysis?

Consistency
-> Viscous (fluid)
-> Mucous
-> Purulent
-> Frothy

Quantity -> teaspoon, cupful etc.

Odour -> fetid = ?bronchiectasis / ?lung abscess

Question 5

What questions do you want to ask about a HAEMOPTYSIS hx?

Answer 5

Origin
-> Differentiate haemoptysis from haematemesis
-> Was it coughed 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 6

What is the pain acronym?

Answer 6

SOCRATES

Question 7

What questions do you want to ask in the PMH section of a resp Hx?

Answer 7

Previous respiratory problems
-> IF they do = how well controlled

Pneumonia -> bronchiectasis / pulmonary fibrosis

Tuberculosis can reactivate

Sev measles / Whooping cough -> bronchiectasis

Asthma

Recent surgery:
-> Dental surgery = aspiration of purulent
material or fragments of tooth
-> Abdominal / Pelvic / Orthopaedic surgery are
risk factors for DVT / PE

Cardiac disease -> pulmonary oedema:
-> ask specifically about:
Angina / Orthopnoea / PND

Immunocompromised:
HIV / Immunosuppression post-transplant
surgery -> ?predispose to atypical infections

Question 8

What questions do you want to ask in the DHx section of a resp Hx?

Answer 8

ALLERGIES - DUST / PETS / POLLEN ETC

Inhalers

Steroids

Abx

ACEi -> dry cough

Amiodarone (pulmonary fibrosis)

Beta-blockers (may worsen airways obstruction),

NSAIDS

Oxygen therapy

SE / Adherence / OTC / HERBAL / TECHNIQUE

Question 9

What questions do you want to ask in the FHx section of a resp Hx?

Answer 9

Infections may be transmitted between family members

There is a genetic predisposition to allergic conditions (e.g. asthma)

Alpha1-antitrypsin deficiency is a genetic cause of emphysema

Question 10

What questions do you want to ask in the SHx section of a resp Hx?

Answer 10

Occupation
-> industrial hazards -> dusts, asbestos

Smoking

Pets (can transmit infection/cause hypersensitivity
reactions)

Overseas travel

Living conditions e.g. damp

Alcohol

Exercise

ADLS / independence / Support