What are examples of appropriate history-of-present-illness questions to ask a patient with a chief complaint of a respiratory issue?

Essential History-of-Present-Illness Questions for Patients with Respiratory Complaints

The most comprehensive approach to gathering history from patients with respiratory complaints should include questions about the nature of breathing difficulties, cough characteristics, associated symptoms, exacerbating factors, and medical history to accurately diagnose and manage the underlying condition.

Core Symptom Assessment

Breathing Difficulties

• Ask about shortness of breath and its severity: "Do you experience shortness of breath?" 1
• Determine activity limitations: "Do you have shortness of breath when walking quickly on level ground or walking up a slight hill?" 1
• Assess functional impact: "Do you have to stop for breath when walking at your own pace on level ground?" 1
• Evaluate impact on activities of daily living: "Do you experience shortness of breath when washing or dressing yourself?" 1
• Determine occupational impact: "Does shortness of breath interfere with your job?" 1

Cough Characteristics

• Inquire about cough productivity: "Do you have a cough that produces phlegm (thick sputum)?" 1, 2
• Ask about timing: "Does coughing wake you early in the morning?" 1
• Determine positional influences: "Does coughing occur primarily when you are lying down?" 1
• Screen for concerning symptoms: "Have you coughed up blood in the last month?" 1

Associated Symptoms

• Ask about wheezing: "Do you experience wheezing?" 1
• Determine functional impact: "Does wheezing interfere with your job?" 1
• Inquire about chest pain: "Do you experience chest pain when breathing deeply?" 1
• Screen for other respiratory symptoms: "Do you have any other symptoms that might be related to lung problems?" 1

Contextual Factors

Timing and Progression

• Determine onset: "When did your respiratory symptoms begin?" 3
• Ask about progression: "Have your symptoms been getting better, worse, or staying the same?" 3, 4
• Inquire about patterns: "Are your symptoms constant or do they come and go?" 3

Exacerbating and Relieving Factors

• Identify triggers: "Do any specific activities, environments, or substances make your symptoms worse?" 3, 4
• Ask about alleviating factors: "What helps improve your symptoms?" 4
• Inquire about medication response: "Have you tried any medications for these symptoms? Did they help?" 5

Medical History

Respiratory History

• Ask about previous lung conditions: "Have you ever had asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, or other lung problems?" 1
• Inquire about chest injuries: "Have you had any chest injuries or surgeries?" 1
• Screen for occupational exposures: "Have you been exposed to asbestos, silica, or other harmful substances at work?" 1

Cardiovascular History

• Screen for heart conditions: "Have you ever had a heart attack, heart failure, high blood pressure, or irregular heartbeat?" 1
• Ask about cardiovascular symptoms: "Do you experience chest pain or tightness during physical activity?" 1

Risk Factors and Habits

• Inquire about smoking: "Do you currently smoke or have you smoked in the past month?" 1
• If yes, determine smoking history: "At what age did you start smoking? How many packs per day? If you quit, how long ago?" 1
• Ask about medication use: "Do you take any medications for breathing problems, heart trouble, blood pressure, or seizures?" 1

Red Flag Assessment

Critical Symptoms

• Screen for severe distress: "Are you having trouble completing sentences due to breathlessness?" 6
• Assess for life-threatening signs: "Have you experienced sudden, severe shortness of breath?" 7, 6
• Inquire about associated symptoms: "Have you had fever, chest pain, or swelling in your legs?" 1, 7

Impact on Daily Life

• Determine functional limitations: "How have these respiratory symptoms affected your daily activities?" 1, 3
• Assess sleep impact: "Do your respiratory symptoms disturb your sleep?" 1
• Inquire about quality of life: "How would you rate the impact of these symptoms on your overall quality of life?" 3

Common Pitfalls to Avoid

• Avoid focusing solely on respiratory symptoms without considering cardiac causes, as many respiratory complaints may have cardiac origins 1, 3
• Don't overlook the multifactorial nature of dyspnea, as it can result from multiple concurrent conditions 3
• Remember to assess the impact of symptoms on quality of life and functional status, not just the presence of symptoms 1, 3
• Be alert to "red flag" symptoms that require urgent attention, such as hemoptysis or severe, sudden-onset dyspnea 1, 7