UNIVERSITY OF BAGHDAD

COLLEGE OF MEDICINE
2022-2023

HISTORY NOTES
The respiratory system
Grade: Three
Module: CA
Speaker: Internal medicine department
Date: 30th October 2022
PRESENTING COMPLAINT
WHAT ARE THE PRESENTING COMPLAINTS OF
RESPIRATORY DISEASES ?
❑ Cough
❑ Wheeze
❑ Sputum
❑ Haemoptysis
❑ Breathlessness
❑ Chest pain
❑ Respiratory pattern
COUGH

 Cough is a characteristic sound caused by a forced expulsion

against an initially closed glottis.
 Acute cough is one lasting less than 3 weeks; chronic cough
lasts more than 8 weeks.
 Ask about the duration of the cough and when, during the
day, it is most severe.
 Cough on lying down in the evening may be due to gastro-
oesophageal reflux
 Cough disrupting sleep is typical of asthma
 Cough on rising in the morning can be caused by
rhinosinusitis and postnasal drip
 Occupational asthma and exposure to dusts and fumes cause
a chronic cough which improves during week ends and
holidays
WHEEZE

 High-pitched whistling sound produced by air passing through narrowed small

airways
 Ask about precipitating factors such as exercise and exposure to allergens
(pets, pollens) and relationship to occupation
What are stridor and stretor
 Stridor is a high-pitched, often harsh noise produced by airflow turbulence
through a partial obstruction of the upper airway. It occurs most commonly on
inspiration but also on expiration or biphasically.
 Stertor, or muffled ‘hot potato’ speech, occurs with naso or oropharyngeal
blockage, e.g. quinsy
SPUTUM

 Sputum is mucus produced from the respiratory tract. The normal lung
produces about 100 ml of clear sputum each day, which is transported to the
oropharynx and swallowed.
What are the important points that should be asked about sputum ?
 Ask patients specifically about sputum as they may find it difficult to discuss
or may swallow it.
 Ask about the colour of any sputum produced and how many tea spoonfuls are
coughed up daily
HAEMOPTYSIS

 Haemoptysis is coughing up blood from the respiratory tract

and always requires investigation
 Establish the volume and nature of the blood.
 Clarify whether the blood was coughed up from the
respiratory tract, vomited (upper gastrointestinal tract) or
suddenly appeared in the mouth without coughing
(nasopharyngeal).
CHEST PAIN

 Characterise chest pain using SOCRATES

 Chest pain can originate from the parietal pleura, the chest
wall and mediastinal structures .

 The lungs do not cause pain because their innervation is

exclusively autonomic.
WHAT ARE THE CHARACTERS OF
PLEURITIC CHEST PAIN ?
Pleuritic chest pain is sharp, stabbing and intensified by
inspiration or coughing.
❖Irritation of the parietal pleura of the upper six ribs causes
localised pain.
❖ Irritation of the parietal pleura overlying the central
diaphragm innervated by the phrenic nerve is referred to the
neck or shoulder tip.
RESPIRATORY PATTERN

Ask about any change in the rate or pattern of

breathing.
 If the patient has daytime sleepiness, ask the
patient’s bed partner about apnoea, loud
snoring, nocturnal restlessness, irritability and
personality change
PREVIOUS HISTORY OF ILLNESS
DRUG HISTORY

 Detail the type of inhaler, dose in micrograms (not puffs) and

frequency.
 Ask patients to demonstrate how they use the inhaler to
check that they are doing this correctly.
 Note the effectiveness of previously prescribed medications,
e.g. oral corticosteroids and β-agonist inhalers and current
and previous medications, if you suspect drug induced
respiratory disease
FAMILY HISTORY

What are the important things that should be asked regarding family
history ?
 Asthma
 Tuberculosis
 Asbestose exposure through the cloths
 Hereditary disease like cystic fibrosis and α1- antitrypsin deficiency
SOCIAL HISTORY

 Smoking : Calculate the ‘pack year’ consumption . If the patient

stopped smoking establish when patients started and stopped smoking
and their average tobacco consumption as cigarettes/day

 Pets : Ask about exposure to pets. Hair and fur from dogs, cats, rodents
and horses may aggravate asthma. Hypersensitivity pneumonitis and
psittacosis are associated with birds.
OCCUPATIONAL HISTORY

Occupation is important in many respiratory disorders. Record all the

occupations, full- and part time, since the patient left school and the number of
years spent in each job
Many respiratory diseases can be caused by exposure to certain substances by
the job
Mention five respiratory diseases caused by occupation ?
❖baker’s asthma
❖farmer’s lung
❖Byssinosis
❖asbestosis
❖ mesothelioma
THANK YOU