Breathlessness history
Before
starting
- Introduce
yourself to the patient.
- Confirm
his name and date of birth.
- Explain
that you are going to ask him some questions to uncover the nature of his
breathless-
ness, and obtain his consent.
- Ensure
that he is comfortable.
The history
• Name, age, and occupation.
Presenting complaint
- Ask
about the nature of the breathlessness. Use open questions.
- Elicit
the patient’s ideas, concerns and expectations (ICE).
History of presenting complaint
Ask about:
- Onset,
duration, and variability of breathlessness.
- Provoking
and relieving factors. Provoking factors include stress, exercise, cold
weather, pets,
dust, and pollen; relieving factors include rest
and use of inhaler or GTN spray.
- Severity:
– exercise tolerance: “How far can you walk
before you get breathless? How far could you walk before?”
– sleep disturbance: “Do you get more breathless
when you lie down? How many pillows do you use?”
– paroxysmal nocturnal dyspnoea: “Do you wake up in the middle of the
night feeling breathless?”
- Associated
symptoms (wheeze, cough, sputum, haemoptysis, fever, night sweats,
anorexia, loss
of weight, lethargy, chest pain, dizziness, pedal
oedema).
- Effect
on everyday life.
- Previous
episodes of breathlessness.
- Smoking
and alcohol.
Past medical history
- Current, past, and childhood illnesses. Ask specifically about
atopy (asthma/eczema/hay fever), PE/DVT, pneumonia, bronchitis, and
tuberculosis.
- Previous investigations (e.g. bronchoscopy, chest X-ray).
- Previous hospital admissions and previous surgery.
Drug history
- Prescribed medication (especially bronchodilators, NSAIDs, b-blockers, ACE inhibitors, amiodarone, and steroids) and route
(e.g. inhaler, home nebuliser).
- Over-the-counter medication.
- Recreational drugs.
- Allergies
Family history
• Parents, siblings, and children. Focus especially on respiratory
diseases such as atopy, cystic fibrosis, tuberculosis, and emphysema (a1-antitrypsin deficiency).
Social history
- Smoking:
1 pack year is equivalent to 20 cigarettes per day for 1 year.
- Recent
long-haul travel.
- Exposure
to tuberculosis.
- Contact
with asbestos (mesothelioma).
- Contact
with work-place allergens involved in, for example, baking, soldering,
spray painting.
- Contact
with animals, especially cats, dogs, and birds (bird fancier’s lung).
After taking the history
- Ask the
patient if there is anything else he might add that you have forgotten to
ask.
- Thank
the patient.
- Summarise
your findings and offer a differential diagnosis.
- State
that you would like to examine the patient and carry out some
investigations to confirm
your diagnosis.