History Taking : Shortness of Breath

Introduction 

My name is Dr A and I am here today to ask you a few questions about what brings you to hospital today.

I believe you have been having increasing shortness of breath.

Would you be able to tell me in more detail about it so we can try to find out t he possible causes for this.

History of present Illness

ODPARRA

Onset :

Can you please tell me how did the problem start?

Did it happen suddenly or over a period of time ?

Establish a baseline functional status : What was your breathing like about 6 months ago ?

Is the breathlessness constant or intermittent ?

If intermittent , how frequently do you experience breathlessness ?

Duration:

How long has this been going on for?

Is it the first time you have experienced this or has it happened before?

Progression:

Is it getting worse with time ? or staying same or improving ?

Aggravating Factors :

What worsens your shortness of breathlesness.

Is it present at rest ?

Does exertion make it worse ?

Does it get worse on lying down ?

Relieving Factors :

Does it get better with rest ?

Do any medications make it better ? eg nebulizers,inhalers or sub lingual nitrates ?

Associated Factors

Any chest pain ?

This is suggestive of ischemic / cardiac origin.

Any palpitations :

They indicate presence of underlying arrhythmia which can be exertional and would mean : AF / atrial flutter or ventricular arrhythmias.

Ask the patient is their heart beat regular or irregular during arrhythmia and if they could tap out the beat.

Also if they have measured their heart beat.

Any Orthopnea or PND: Paroxysmal Nocturnal Dyspnea are suggested of left Ventricular Dysfunction.

Peripheral oedema is suggestive of CCF or Cor – pulmonale.

Respiratory symptoms :

Any cough ? Dry or productive,

Any wheeze , Any Haemoptysis ?

If productive color of sputum and amount

A dry non- productive cough suggests viral etiology,or Interstitial lung disease

A productive / suppurative cough is suggestive of infection,suppurative lung diseases or malignancy.

Haemoptysis occurs in malignancy , PE or infection or pulmonary congestion especially with mitral stenosis

Any exceesive use of steroids ( eg Asthma or Rheumatoid arthritis causing immunusupression leading to PCP pneumonia )

Vasculitic symptoms and Sarcoidosis

Any leg pains

Any skin rash

Muscle aches suggestive of vasculitis

Any increased use of steroids ( can cause pneumocystis carinii pneumonia )

Any History of HIV / Immunosuppression ( can cause pneumocystis carinii pneumonia )

Any cold , fevers  : Any flu like symptoms :Viral etiology

Any weight loss : Malignancy / TB

Do you keep any pets : Psittacosis / allergic bronchitis

What is your occupation : Occupational lung disease : Do symptoms improve when away from work ?

Any irritation in eyes

Any swollen glands ? ( lymphadenopathy) : TB / Sarcoidosis / Malignancy

Any recent contact with some one with TB

Any change in bowel habits

Any blood in stools

Ay Jaundice ( Yellow discoloration of eyes/ sclera)

Any recent travel abroad

Any use of Recreational drugs : or IV abuse ( HIV / Hepatitis B / Immunosuppression )

Medications :

Ask about full list of medications and compliance to therapy.

Appetite suppressors eg fenfluramine is associated with pulmonary hypertension.

Social Issues :

Ask about smoking ( cigarettes / day and pack years)

Alcohol consumption

Occupation

Impact of symptoms on daily living.

Any concerns the patient may be having ?