The respiratory history should focus on key system-specific symptoms related to the respiratory system.
A respiratory history focuses the consultation on the respiratory system. This is usually because a patient presents with a respiratory problem such as shortness of breath or wheeze.
The idea of a system-specific history is to explore key factors that are relevant to the affected system during the consultation. In respiratory disease, this may include pertinent past medical history (e.g. asthma/COPD), inhaler use, smoking history, occupational exposures, and even childhood illnesses.
Breathlessness is a major symptom of respiratory disease.
Shortness of breath or breathlessness is a very common symptom related to many underlying pathologies including lung disease. It is important to determine the onset and chronicity of breathlessness. For example:
As well as onset, you need to determine the duration of breathlessness, whether it is getting better or worse, and whether it is associated with any other symptoms (e.g. chest pain with pulmonary embolism). It is useful to ask when the breathlessness is worse. For example, is it exacerbated at work that might suggest occupational asthma.
The key symptoms to determine in the respiratory history include:
It is vital to determine whether there is any pre-existing lung disease.
Ask about any pre-existing lung diseases such as asthma, COPD, or bronchiectasis. With each condition, determine whether these are well controlled (i.e. minimal symptoms) or poorly controlled (i.e. recurrent symptoms despite treatment).
When discussing previous medical problems always establish:
With pulmonary disease, remember to ask about any previous TB!
Patients with pulmonary disease may have undergone previous thoracic surgery.
Establish whether the patient has undergone thoracic surgery including the type of operation, date, and any complications. If the patient had surgery for lung cancer, determine if they are still under follow-up or having adjuvant therapy (i.e. treatment after surgery).
It is essential to note the type of inhaler, device, concordance, and technique with every patient.
Remember to ask all patients about inhalers and other medications during the consultation. Don’t forget to ask about adaptors (e.g. spacer) and whether they are getting side-effects.
Ensure you ask about any current or recent steroids courses. Consider asking about steroid side-effects if long-term use or recurrent courses.
Some pulmonary diseases are inherited like cystic fibrosis.
Ensure you enquire about any conditions that run through the family and consider drawing out a family tree. It is useful to know whether any family members have a history of atopy or have previously been diagnosed with TB.
It is vital to determine the functional impact of their symptoms, particularly breathlessness.
Relevant components on social history that are related to respiratory disease include:
When determining the functional impact of their symptoms such as breathlessness, ensure you ask them questions relative to their daily life:
Answers to these questions can be used to determine the grade on the Medical Research Council (MRC) dyspnoea scale. This is a scale graded 1-5 based on the severity of breathlessness.
Always end by discussing the patient's ideas, concerns & expectations.
Have comments about these notes? Leave us feedback