HISTORY TAKING RESPIRATORY SYSTEM

OUTLINE PERSONAL INFO CHIEF COMPLAINTS PRESENT HISTORY REVIEW OF SYSTEMS PAST HISTORY PERSONAL HISTORY SOCIAL HISTORY FAMILY HISTORY DRUG HISTORY TRAVEL HISTORY

PERSONAL INFO NAME AGE SEX OCCUPATION MARITAL STATUS ADDRESS & PHONE NO.

CHIEF COMPLAINTS –What brought the patient to the hospital? COUGH SPUTUM HAEMOPTYSIS BREATHLESSNESS CHEST PAIN

COUGH DURATION – how long have you had this cough? –Acute (< 3 weeks) –Chronic (> 8 weeks)

ACUTE COUGH - CAUSES Viral URTI Acute bronchitis (bacterial) Inhaled foreign body Pneumonia

CHRONIC COUGH - CAUSES Asthma GORD Rhinitis-Sinusitis Smoking Drugs – ACE Inhibitors Lung malignancy TB Bronchiectasis Interstitial lung disease

Associated symptoms Do you have any of the following symptoms? Haemoptysis Breathlessness Fever Chest pain Weight loss Syncope

Cough - Character What is the nature of the cough? Wheezy cough – Asthma, COPD Bovine cough – lung malignancy with invasion of left Recurrent laryngeal N. Barking, Painful – Inflammation of trachea and larynx

Moist or dry Is the cough dry or moist? Moist cough Ac. Or Chr. Bronchitis Bronchiectasis Dry cough Tracheitis – painful Drug induced – ACEI Chronic dry cough Interstitial lung disease Malignancy

Timing Do you wake up coughing in the night? –Asthma Does your cough decrease on holidays? Occupational Does your cough increase during the day? GORD, chronic sinusitis

SPUTUM Do you bring out phlegm while coughing? Ask about amount, colour, taste/smell, solid material in sputum

Amount How much sputum do you cough out each day? – Spoonful or cupful Copious, purulent sputum – Bronchiectasis Sudden, large, purulent sputum – –Rupture of lung abscess into bronchi Large volume, watery, frothy pink sputum –Pulmonary oedema

Colour What is the colour of sputum? –Serous –Mucoid –Purulent –Rusty

Serous sputum Clear watery, frothy, pink –Acute pulmonary oedema –Malignancy

Mucoid Clear, grey, white, viscid –Chronic bronchitis –COPD –Asthma

Purulent sputum Is your sputum yellowish? –Acute infection –Greenish? Chronic infection –Pneumonia –Bronchiectasis –Cystic fibrosis –Lung abscess

Rusty sputum Is the sputum rusty red? –Pneumococcal pneumonia

Taste/Smell Foul smelling (anaerobic infection) –Anaerobic bacteria Bronchiectasis Lung abscess Empyema

Solid material Mucus plugs –Asthma –Bronchopulmonary aspergillosis

HAEMOPTYSIS Did you cough out blood? Differentiate from haemetemesis Ask about amount, appearance, duration and frequency

Haemoptysis - causes Malignancy Infection Vascular – PTE, infarction Vasculitis – Wegener’s, Goodpasture Trauma – FB, chest trauma, iatrogenic Cardiac – MS, Ac. LVF Coagulopathy

Amount and appearance Blood streaked clear sputum / blood clot –Lung carcinoma Blood streaked purulent sputum – infection Large amounts of blood – Lung carcinoma Bronchiectasis Tuberculosis

Duration & frequency Intermittent haemoptysis with infection for several years –Bronchiectasis Daily haemoptysis for more than a week - Carcinoma, TB, Lung abscess Single large haemoptysis episodes - Pulmonary Thromboembolism, infarction

BREATHLESSNESS Shortness of breath Undue awareness of breathing (dyspnoea) Normal during strenuous exercise

Mode of onset, duration & progression Did it occur suddenly and progress over minutes? –PTE –Pneumothorax –Acute LVF –Asthma –FB

Did it occur gradually and progress over hours to days? –Pneumonia, asthma, exacerbation of COPD Weeks to months? Anaemia, Pl. effusion Months to years? COPD, Pulm. Fibrosis, PTB

Associated symptoms Lightheadedness Dizziness, Tingling Chest tightness

Acute breathlessness Without chest pain –P. embolism –Pneumothorax –Met. Acidosis –Acute LVF

Acute breathlessness With Pleuritic pain –Pneumonia –Pneumothorax –P Embolism –Rib fracture

Acute breathlessness Central chest pain –MI –Massive p. embolism With wheeze and cough Asthma COPD

Severity Gr. 1 – when hurrying on level ground Gr. 2 – when walking with people of own age or on level ground Gr. 3 – has to stop when walking on level ground or with people of own age

Aggravating – relieving factors Orthopnoea –cardiac cause, severe lung disease Wakes up pt. from sleep –Acute LVF, asthma Worse on waking, improves with coughing - COPD

Chest pain Usually originates from pleura, chest wall or mediastinal structures

Pleural pain Sharp, stabbing, worsens on coughing/inspiration –P. embolism –Pneumonia –Pneumothorax –Rib fractures

Past history Known allergies – asthma Known patient of asthma Frequent episodes of infections –Bronchiectasis Known patient of tuberculosis? History of connective tissue disease? History of lung malignancy?

Drug history Drugs for asthma, route, dose ACE Inhibitor intake - cough

Family history Cystic fibrosis – inherited Alpha 1 antitrypsin deficiency – Emphysema History of Allergies TB

Social history Smoking (pack years) –COPD (> 20 pack year history) –Cancer Pets allergies - asthma

Occupational Exposure to asbestos (construction workers, metal miners) –Malignancy –P. fibrosis Allergens (animals, plant products, dusts, chemicals) - asthma