Respiratory Histories Laz Overview Topics Shortness of Breath

Respiratory Histories Laz

Overview Topics • Shortness of Breath • Cough

Basic Structure for Taking a History • • • Introduction History of Presenting Complaint (HPC) Associated Symptoms & Risk Factors ICE Past Medical History (PMH) Drug History and Allergies (DH&A) Family History (FH) Social History (SH) Summary • NOTE: this is not essential, you can do a summary at any point during the history

Shortness of Breath When did it begin? Acute Chronic

Shortness of Breath Differential Diagnosis • Pulmonary embolism • Pneumothorax • Pneumonia • Acute Asthma KEY: Acute = RED Chronic = BLUE Acute/Chronic = AMBER • • • Chronic Asthma Heart failure COPD Pulmonary Fibrosis Lung cancer Anaemia/Hyperthyr oidism • Bronchiectasis • Tuberculosis

Shortness of Breath History of Presenting Complaint • How suddenly did it begin? • Does anything make it better or worse? • Has this happened before? • How far can you walk before you become breathless? Has this improved/got worse?

Shortness of Breath – Associated Symptoms • • Cough Chest pain Leg pain FLAWS Fatigue Hyperthyroid symptoms (Anaphylaxis)

Shortness of Breath – Associated Symptoms Pneumonia, Heart Failure, TB, COPD, Bronchiectasis Cough TIVE C U D PRO HAEMOPTYSIS DRY Chest Pain Asthma, Pulmonary Fibrosis PE, pneumothorax, pneumonia ITIC R PLEU TIGH PE, Lung cancer, Bronchiectasis, TB TNES S Asthma

Shortness of Breath – Associated Symptoms Leg Pain PE FLAWS Lung cancer, TB Fatigue Many conditions (incl. anaemia) Hyperthyroidism

Shortness of Breath – Risk Factors (PASTO) Pets Allergies Smoking Travel Occupational History Asthma, Pulmonary Fibrosis Asthma Lung Cancer, COPD, Heart Failure TB Asthma, Pulmonary Fibrosis, Lung Cancer

Shortness of Breath – Rest of the History PMH • • ‘Have you ever had to see your GP about anything in the past? Any hospital admissions or operations? ’ Enquire about heart or lung conditions (e. g. a history of ischaemic heart disease increases the risk of heart failure) DH&A • • Do NOT forget ALLERGIES Drugs associated with pulmonary fibrosis – amiodarone, nitrofurantoin, cyclophosphamide, penicillamine (and a few more) FH • • Atopic conditions (asthma, eczema, hay fever, food allergy) Close contacts with similar illness (pneumonia, TB) SH • • Mainly covered by PASTO Ask about impact on quality of life

Cough When did it begin? Acute PRODUCTIVE DRY Chronic PRODUCTIVE DRY

Cough – Differential Diagnosis Acute Chronic Dry Productive Asthma Post-nasal drip URTI Drug-induced Pneumonia Asthma GORD COPD TB Lung Cancer Bronchiectasis Pulmonary oedema (heart failure)

Cough – Features of the Cough (HPC) Lung Cancer, TB, Bronchiectasis Blood Frothy Sputum Pulmonary Oedema Pneumonia, Bronchiectasis Yellow/Green Sputum WN Timing LYING DO NIGHT /E ARLY M ORNIN G Pulmonary Oedema, GORD Asthma

Cough – Associated Symptoms SOB FLAWS Chest Pain Wheeze Asthma, Pneumonia, COPD, Lung Cancer, TB, Bronchiectasis, Pulmonary Oedema Lung cancer, TB Asthma (tightness), GORD (epigastric) Asthma, COPD

Cough – Rest of the History PMH • • • History of asthma/GORD/hay fever/heart disease/chest infection? ATOPIC conditions (asthma, eczema, hay fever, allergies) Recent travel abroad (think TB) DH&A • ACE inhibitors FH • • Atopic conditions Close contacts with similar symptoms (infection) SH (mainly PASTO) • • Smoking (lung cancer, COPD, heart failure) Occupation (asbestos mesothelioma/pulmonary fibrosis) Change of house/school/office (environmental triggers) Pets (asthma trigger)

Thank You! Questions: www. facebook. com/lasithranasinghe lpr 114@ic. ac. uk