The Respiratory History

8/3/2019 The Respiratory History

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complaintshistory of present complaint

past historyfamily historypersonal and social history


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CoughSputumHaemoptysisDyspnoeaWheezeChest pain

FeverNight sweatsHoarseness


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Duration ?Time of appearance?

Character?Exacerbating factors?Dry or Productive?


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Acute cough (


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C hronic cough

A sthmaUpper airway cough syndromeBronchiectasisA CE inhibitor medicationCarcinoma of the lungCardiac failure


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Worse at night asthma or heart failure


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Barking - A cute croup (emergency), followedby stridor

Loud and brassy -Tracheal compression by atumourHollow sound ( bovine cough ) - Recurrentlaryngeal nerve palsy


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Immediately after eating or drinking oesophageal reflux, rarely a tracheo-

oesophageal fistula.


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What color?How much do you cough up?


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Yellow/ green sputum suggests infection, eg.bronchiectasis or lobar pneumonia

Foul-smelling dark-coloured sputum mayindicate the presence of a lung abscess withanaerobic organismsPink frothy secretions suggest pulmonaryoedema due to left heart failure


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Volume?Mild haemoptysis

- less than 20 mL in 24 hours- appears as streaks of blood discolouring

sputum.Massive haemoptysis

- more than 250 mL of blood in 24 hours andrepresents a medical emergency


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Favours haemoptysis Favours haematemesis

Mixed with sputum Follows nausea

Occurs immediately after coughing

Mixed with vomitus;follows dry retching


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Common Causes of Hemoptysis

a) RespiratoryBronchitisBronchial carcinomaBronchiectasis

PneumoniaPulmonary infarctionCystic fibrosisLung abscessTuberculosisForeign body

Goodpasture s syndromeRupture of a mucosal blood vesselb) Cardiovascular

Mitral stenosisA cute Left ventricular failure

c) Bleeding diastheses


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O nset?Duration?

Severity?- Worsens progressively over a period of

weeks, months or years may be due topulmonary fibrosis.V ariability?

- Diurnal variation: asthma


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A llergens- asthmaPhysical exertion

Lying flatWaking up

Left heart failure


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C lass SymptomsI Heart disease present, but no undue dyspnoea

from ordinary activityII Comfortable at rest; dyspnoea on ordinary

activitiesIII Less than ordinary activity causes dyspnoea,

which is limitingIV Dyspnoea present at rest, all activity causes

discomfort


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A whistling sound made by the flow of high-velocity air through narrowed airwaysMaximal during expiration and isaccompanied by prolonged expirationCauses: A sthma, COPD, infections such asbronchiolitis, airways obstruction by a foreign

body or tumour.


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Pleural pain:- sharp and made worse by deep inspiration

and coughing- typically localised to one area of the chest- may be of sudden onset in patients with lobar

pneumonia, pulmonary embolism andinfarction or pneumothorax, and is oftenassociated with dyspnoea


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Bacterial pneumoniaV iral pneumonia

Tuberculosis


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Episodes of drenching sweating at night :Tuberculosis


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Previous repiratory diseasePrevious repiratory investigations

SpirometryPrevious lung surgeryTreatment


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MinerFactory workers

Exposure to mouldy hay, humidifiers or airconditionersExposure to animals including birds


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SmokingCalculate the number of packet-years of smoking

Number of pack years =(number of cigarettes smoked per day x number of

years smoked)/20A lcohol consumptionIntravenous drug users


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A sthma or other atopic diseasesLung cancer

Emphysema ( A lpha1-antitrypsin deficiency)Tuberculosis

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The Respiratory History