Shortness of breath – History
Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES
Introduction (WIIPP)
- Wash your hands
- Introduce yourself: give your name and your job (e.g. Dr. Loiuse Gooch, ward doctor)
- Identity: confirm you’re speaking to the correct patient (name and date of birth)
- Permission: confirm the reason for seeing the patient (“I’m going to ask you some questions about your cough, is that OK?”)
- Positioning: patient sitting in chair approximately a metre away from you. Ensure you are sitting at the same level as them and ideally not behind a desk
History of presenting complaint
- Onset and duration of shortness of breath
- If they are uncertain about the start of the shortness of breath, a good question is: “When were you last well?”
- Acute, chronic, constant, intermittent
- Exacerbating factors
- Effort, dust exposure
- Alleviating factors
- Rest, inhalers, GTN spray
- Timing
- Relation to exertion, time of day (morning dips in asthma)
- Associated symptoms
- Wheeze or stridor?
- Cough: productive or dry, colour of sputum, change in colour of sputum?
- Hemoptysis: how much (teaspoonful, cupful), how frequently?
- Chest pain: pleuritic, cardiac-sounding, nausea, sweating?
- Constitutional symptoms: fever, weight loss (quantify how much), night sweats?
- Cardiac symptoms: palpitations, ankle swelling, PND, orthopnoea?
- Exercise tolerance
- Quantify how far the patient can walk before stopping due to shortness of breath (e.g. number of stairs, distance on the flat)
Past medical history
- Full medical history but ask specifically about:
- Asthma
- Frequency of attacks, admission to hospitals, admissions to ITU, need for non invasive ventilation (NIV)
- COPD
- Frequency of exacerbations, admissions (as for asthma): home oxygen (number of hours and rate of flow), any home nebulizers.
- PE/DVT risk factors
- Long whole travel, malignancy, recent surgery, pregnancy, procoagulant stage
- Other resp
- Recurrent lower respiratory tract infractions (e.g. number in the last year, any antibiotics taken)
- Cardiac
- Past history of ischemic heart disease, cardiac failure or structural heart disease.
- Arrhythmia (e.g. atrial fibrillation)
Drug history
- Full drug history, especially:
- Nebulisers
- Home oxygen
- Cardiac medications, including: diuretics: ACE inhibitors, antianginals
Family history
- Atopy
- Asthma, eczema, hay fever
- Tuberculosis
- Any recent contact?
Social history
- Smoking history (active and passive): quantify pack years
- Exposure
- Occupational exposure
- Coal, dust, asbestos, fumes, moulds (e.g. hay)
- Animal exposure
- Pets (especially birds), farming, any animals involved in hobbies
- Tuberculosis exposure
- Limitations of daily activities by shortness of breath
- e.g. any hobbies you can no longer perform due to your breathing?
Click here for the differential diagnosis of shortness of breath
Perfect revision for medical student exams, finals, OSCEs and MRCP PACES
Click here for how to take history in chest pain