1. HISTORY TAKING RESPIRATORY SYSTEM

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

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

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

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

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

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

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

9. 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

10. 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

11. 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

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

13. 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

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

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

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

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

18. Rusty sputum Is the sputum rusty red? –Pneumococcal pneumonia

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

20. Solid material Mucus plugs –Asthma –Bronchopulmonary aspergillosis

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

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

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

24. 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

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

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

27. 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

28. Associated symptoms Lightheadedness Dizziness, Tingling Chest tightness

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

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

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

32. 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

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

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

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

36. 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?

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

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

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

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