Respiratory History

Question 1

What questions do we ask about breathlessness in a respiratory history?

Answer 1

• How is the patient normally? (Is this 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 symptoms e.g. cough, sputum, haemoptysis, pain, wheeze, night sweats, weight loss, oedema
• Severity e.g. at rest? Only on exertion? Limiting ADLs?

Question 2

What questions do we ask about sputum in a respiratory history?

Answer 2

Onset, timing, duration, variation, diurnal variation
• Colour (e.g. rusty sputum suggests pneumococcal pneumonia; frothy pink may indicate pulmonary oedema). Any haemoptysis?
• Consistency (viscous (fluid), mucous, purulent, frothy)
• Quantity (teaspoon, cupful etc.)
• Odour (fetid suggests bronchiectasis or a lung abscess)

Question 3

What questions do we ask about cough in a respiratory history?

Answer 3

• Onset, timing, duration (less than 2 months = acute, more than 2 months = chronic), variation (e.g. recent change in a chronic cough), diurnal variation.
• Productive / unproductive?

Question 4

What questions do we ask about haemoptysis in a respiratory history?

Answer 4

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 5

How do we complete a HPC for a respiratory history?

Answer 5

Your history of presenting complaint should also include:
• Previous respiratory problems
o Pneumonia can lead to bronchiectasis or pulmonary fibrosis
o Tuberculosis can reactivate
o Severe measles or whooping cough can lead to bronchiectasis
o Asthma

• Recent surgery:
o Dental surgery can lead to aspiration of purulent material or fragments of tooth
o Abdominal, pelvic or orthopaedic surgery are risk factors for DVT and possible pulmonary embolus

• Cardiac disease may lead to pulmonary oedema – ask specifically about angina, orthopnoea, paroxysmal nocturnal dyspnoea
• Immunocompromised (e.g. HIV, immunosuppression post-transplant surgery) may predispose to atypical infections

Question 6

What drug history and allergies questions should be asked in a respiratory history?

Answer 6

Inhalers, steroids, antibiotics, ACE inhibitors (may cause cough), amiodarone (pulmonary fibrosis), beta-blockers (may worsen airways obstruction), NSAIDS, oxygen therapy

Question 7

What social history questions should be asked in a respiratory history?

Answer 7

Occupation (industrial hazards e.g. dusts, asbestos)
• Smoking (pack years e.g. 10/day for 30 years = half a pack x 30 = 15 pack years)
• Pets (can transmit infection or cause hypersensitivity reactions)
• Overseas travel
• Living conditions e.g. Damp
• Alcohol
• Exercise, activities of daily living, independence

Question 8

What family history questions should be asked in a respiratory history?

Answer 8

• 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