- How long have you had the shortness of breath?
Why: to determine if acute or chronic.
- Was the onset of shortness of breath sudden or gradual?
Why: if sudden consider adult respiratory distress syndrome, pulmonary embolism, pneumothorax, lung collapse. If gradual onset, consider chronic diseases such as congestive cardiac failure, emphysema and fibrosis.
- What makes the shortness of breath worse?
Why: e.g. exercise , laying flat in bed.
- Recent history of bleeding?
Why: e.g. heavy periods with clots, vomiting blood, bloody stools, rectal bleeding - may suggest anemia as the cause for shortness of breath.
- Past Medical history?
Why: previous respiratory illness (e.g. pneumonia, tuberculosis, chronic bronchitis); previous heart problems (heart disease, heart attack, heart valve disease); HIV infection ( at high risk for Pneumocystis carinii pneumonia); previous high blood pressure; deep venous thrombosis; Rheumatic fever.
- Medications?
Why: many different medications can produce lung problems and resultant shortness of breath e.g. pulmonary embolism from oral contraceptive pill; fibrotic lung diseases from cytotoxic agents such as methotrexate, cyclophosphamide and bleomycin; bronchospasm from beta-blockers or non-steroidal anti-inflammatory medications.
- Cigarette smoking?
Why: number of packets per day and number of years you have smoked. Smoking is a major cause of lung cancer, chronic bronchitis and emphysema. Passive smoking exposure is also regarded as a significant risk.
- Drug taking history?
Why: cocaine, amphetamines or injected narcotic drugs can cause shortness of breath.
- Alcohol history?
Why: The drinking of large amounts of alcohol in binges can sometimes result in aspiration pneumonia and alcoholics are also prone to develop pneumococcal or Klebsiella pneumonia.
- Occupational history?
Why: e.g. exposure to dusts in mining industries and factories such as asbestos, coal, silica, iron oxide, tin oxide, cotton, beryllium, titanium oxide, silver, nitrogen dioxide, anhydrides; exposure to animals (e.g. Q fever or psittacosis); exposure to moldy hay, humidifiers or air conditioners may result in allergic alveolitis.
- Family history?
Why: asthma, cystic fibrosis, emphysema, alpha-1-anti-typsin deficiency, tuberculosis, heart attacks.
Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include:
- Cough?
Why: may be due to lung or heart disease.
- Sputum
Why: color and quantity? - e.g. large volume pus-like suggests bronchiectasis or pneumonia; foul smelling dark colored suggests lung abscess; pink frothy secretions may be due to left ventricular heart failure; blood in sputum can be a serious sign of lung disease and must always be investigated.
- Audible wheeze?
Why: may suggest asthma, chronic bronchitis, emphysema, airways obstruction (by a foreign body or tumor) or left ventricular heart failure.
- Chest pain?
Why: may be due to lung or heart disease.
- Fever?
Why: e.g. fever at night may suggest tuberculosis, pneumonia or mesothelioma ( tumor of lung lining due to asbestos exposure).
- Orthopnea (breathlessness lying down flat)?
Why: suggests left ventricular heart failure.
- Paroxysmal nocturnal dyspnea (inappropriate severe breathlessness causing waking from sleep)?
Why: suggests left ventricular failure.
- Stridor (a rasping noise heard loudest on inspiration)?
Why: indicates obstruction of the larynx, trachea or large airways by a foreign body, a tumor or infection (such as epiglottitis).
- Ankle swelling
Why: may suggest heart failure.
- Palpitations of the heart?
Why: may indicate that heart arrhythmia may be the cause of breath problems.
- Fever and pus-like sputum?
Why: suggests pneumonia.
- Chest pain with blood in sputum?
Why: need to rule out pulmonary embolism.
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