Case
•A 25-year-old man presented with a sudden on-set of SOB and cough.
Symptoms of Respiratory system
- Cough; Persistent Cough in Adults and Chronic Cough in Children,may indicate B.A,GERD , or Cystic fibrosis
- Sputum
- Haemoptysis
- Dyspnoea (acute, progressive or paroxysmal)
- Wheeze
- Chest pain
- Fever
- Hoarseness
- Night sweats, Sleepiness
Other systems
- Loss of appetite is a common feature whenever people are unwell it suggests that the disease is having a significant effect on well-being.
- Significant loss of weight may well be indicative of serious illness - eg, malignancy or tuberculosis.
- Upper gastrointestinal symptoms: gastro-oesophageal reflux is a common cause of chronic cough.
- Heart disease may cause respiratory symptoms. Establish whether there are any indications of heart failure or coronary heart disease.
- Severe anaemia may cause breathlessness.
- Rheumatoid arthritis and other connective tissue diseases may cause respiratory symptoms.
- Neuromuscular diseases may cause respiratory symptoms, particularly dyspnoea.
History
- Presenting complaint (PC)
- History of presenting complaint (HPC)
- Past medical history (PMH) = Resp dis or Hosp admiss
- Family history
- Drug history
- Social history—Occupation
Past medical history
- Use of inhalers (assess compliance and technique).
- Use of steroids (some measure of severity in asthma).
- Other drugs which may have relevance in respiratory disease - eg, angiotensin-converting enzyme (ACE) inhibitors (cough).
- Allergies; Ask about all allergies including, for example, food, inhaled allergens and drugs.
Occupational and social history
- An occupational history may be very important in respiratory disease. - Hobbies and pets may also be responsible for respiratory disease. - Lifestyle and alcohol consumption are also very relevant to respiratory diseases.
- Ask about illicit drugs. - Smoking history should detail, for example, the type and number of cigarettes smoked currently and in the past.
- Ask also about passive smoking. - Sexual history may be relevant to risk of HIV and AIDS.
Family history
- Respiratory diseases with a genetic component - -eg, cystic fibrosis, emphysema (alpha-1-antitrypsin deficiency). - Infectious diseases such as -tuberculosis (remember high-risk groups). - Atopic diseases such as -asthma, hay fever and eczema.