Respiratory History

Question 1

What are the core respiratory symptoms you want to be asking about?

Answer 1

i. Dyspnoea – breathlessness
ii. Cough
a. Productive – Mucus or phlegm
b. Non-productive - dry
c. Sputum/Phlegm - colour
d. Haemoptysis – coughing up blood
iii. Chest pain - SOCRATES
iv. Wheeze – breathing with a whistling/rattling sound

Question 2

What systemic symptoms should you be asking about?

Answer 2

Systemic Symptoms – Weight loss, Fatigue and Fever

Question 3

What other systems could you ask about in the system enquiry?

Answer 3

Cardiovascular - chest pain, palpitations, oedema, syncope, orthopnoea

Gastrointestinal: nausea, vomiting, dysphagia, abdominal pain

Musculoskeletal: chest wall pain, trauma

Question 4

What questions should you ask for the past medical history?

Answer 4

Respiratory Past Medical History
i. Any pre-existing medical (respiratory) conditions – asthma or COPD
ii. Have you previously undergone any operations or procedures?

Question 5

What are some commonly perscribed medications for respiratory disease?

Answer 5

Question 6

What are some examples of medications with respiratory side effects?

Answer 6

Question 7

What questions should you be asking for a respiratory family history?

Answer 7

Family History – “Do any of your family members have lung problems?”

i. Respiratory diseases with a genetic component - eg, cystic fibrosis, emphysema (alpha-1-antitrypsin deficiency).
ii. Infectious diseases such as tuberculosis (remember high-risk groups).
iii. Atopic diseases such as asthma, hay fever and eczema.

Question 8

What things should you be focusing on for a respiratory social history?

Answer 8

Social History
i. Important for respiratory conditions – occupational asthma, Industrial dust disease, Asbestos-related diseases, etc.
ii. Living situation – support network - who they live with?
iii. Hobbies and pets – Asthma
iv. Lifestyle
v. Alcohol and recreational drugs – frequency and volume
vi. Smoking history – quantity and length
vii. Sexual history

Question 9

What is asthma?

Answer 9

Chronic airway inflammation – hyper-responsive airways

Question 10

What are the clinical features/presentations for asthma?

Answer 10

• Main symptoms – wheeze, dry/minimally productive cough and breathlessness
• Other symptom - Chest tightness or pain
• Symptoms are typically episodic and diurnal (worse at night and early morning)
• Typically present in younger age (COPD more typical at an older age)

Question 11

What are the risk factors for asthma?

Answer 11

• Non-modifiable – Personal/Family history of atopy, male sex (development), female sex (persistence into adulthood), premature and low birth weight
• Modifiable – Exposure to tobacco smoke, inhaled particulates and occupational dust, obesity, social deprivation and infection in infancy.

Question 12

What are some important things to cover in an asthma history?

Answer 12

• Triggers – pets, carpets, temperature
• Occupation
• Frequency of exacerbations
• Personal or family history of atopy
• Best expected and recent peak expiratory flow rate (PEFR)
• Adherence with treatment
• Smoking (including passive smoking) history

Question 13

What is COPD?

Answer 13

• Lung disease characterised by persistent respiratory symptoms and airflow obstruction.
• COPD is a triad of emphysema (alveoli become damaged), chronic bronchitis (airways become irritated and narrowed) and small airway fibrosis.

Question 14

What are the clinical features of COPD?

Answer 14

• Main Symptoms – progressive shortness of breath (initially exertional but can progress to resting) and chronic productive cough (colourless but can become green during lower respiratory tract infection.
• Other symptoms – recurrent lower respiratory tract infection, fatigue, headache and persistent wheeze?
• Typically presents in older age

Question 15

What are the risk factors for COPD?

Answer 15

Risk Factors
* Tobacco smoking - associated with 80% of COPD cases
* Indoor air pollution: this usually occurs in the developing world, where biomass is burnt inside homes for cooking and heating
* Alpha-1 antitrypsin deficiency – increased alveolar destruction – resulting in early-onset emphysema – associated with liver disease

Question 16

How is COPD different to asthma in terms of clinical presentation?

Answer 16

a) Persistent productive cough
b) Progressive SOB
c) Constant – less episodic/diurnal
d) Associated with smoking
e) Older Age
f) Not associated with atopy
g) Bronchodilator reversibility – not fully reversible