SOB and cough

Question 1

What to ask while taking Hx of a patient with shortness of breath?

Answer 1

• Symptom of dyspnoea- When, how, how often, what else
• When- When does it start ( time of day, triggers, relationship to medications)
• How – How does it present ( gradual onset vs sudden onset)
• How often – All the time/ some of the time/ first episode
• What else- Associated symptoms
• Cough – productive/non-productive; sputum character
• Haemoptysis
• Chest pain/ tightness/ wheeze/ stridor/
• Palpitations
• Features of VTE
• Allergic symptoms

Question 2

What to ask in PMH in a palliative patient with SOB?

Answer 2

Past medical history- Not always cancer

• Oncology history
• Cardiac history
• COPD/ Undiagnosed COPD ( smoking history, industrial exposure)
• Interstitial lung disease
• OSA; Obesity

Question 3

What to ask in treatment history in a patient with palliative cancer?

Answer 3

Treatment history

• Chemotherapy ( Resp-Bleomycin, Methotrexate, Cyclophosphamide; Cardiac- Anthracyclines, Herceptin)
• Radiotherapy ( especially thoracic, mediastinal and upper abdominal/oesophageal)
• Immunotherapy - ask about previous toxicity, especially autoimmune toxicity
• Hormonal therapies (risk of VTE)
• Always ask about the most recent cycle timing and previous toxicity

Question 4

Signs of respiratory problems (chest expansion, Percussion, breath sounds, added sounds) in:

• pleural effusion
• consolidation

Answer 4

Question 5

Signs of respiratory problems (chest expansion, Percussion, breath sounds, added sounds) in:

• collapse with bronchial obstruction
• upper airway obstruction

Answer 5

Question 6

Signs of respiratory problems (chest expansion, Percussion, breath sounds, added sounds) in:

• pneumothorax
• asthma/COPD

Answer 6

Question 7

Signs of respiratory problems (chest expansion, Percussion, breath sounds, added sounds) in:

• panic
• acidosis

Answer 7

Question 8

Signs of respiratory problems (chest expansion, Percussion, breath sounds, added sounds) in:

• heart failure
• respiratory muscle weakness

Answer 8

Question 10

Ix to consider in SOB

Answer 10

• Bloods ( FBC , CBG/ABG)
• Imaging (CXR, USS, CT, Echo)
• Spirometry
• ECG

Question 11

Supportive measures to management of SOB

Answer 11

Depends on underlying cause of SOB, but in general

• Well ventilated environment, fans
• Breathing exercises
• Cardiac / Pulmonary rehabilitation
• Positioning
• Lifestyle adaptations
• REASSURANCE
• Oxygen therapy
• Use where there is symptomatic hypoxaemia and exercise induced hypoxaemia
• Usually requires respiratory specialist review to be prescribed long term

Question 12

Pharmacological options of SOB management in palliative patient

Answer 12

Question 13

Non-pharmacological options of management of a patient with SOB

Answer 13

Non-Pharmacological

• Non-Invasive Ventilation

Ventilatory failure- used in neuromuscular respiratory failure eg MND and hypercapnic respiratory failure eg COPD

• Procedures
• Blood transfusion
• Drains (Pleural, Ascitic)
• Tracheostomy ( upper airway obstruction)

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Question 14

How do we give benzodiazepines in SOB in palliative pt?

Answer 14

IM - due to rapid onset

Question 15

What do we use if a patient has difficulty with coughing up the secretions?

Answer 15

• carbocysteine
• saline nebulisers
• chest physiotherapy

Question 16

What can we give to suppress cough?

Answer 16

Weak opioids