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Questions & Investigations

SEX

Male or female, 

was a ratio of 3:1 although this is becoming more equal as more women smoke.

AGE

Asthma occurs at any age, COPD usually presents over 40yrs of age.

SYMPTOMS

Cough, wheeze, breathlessness, sputum volume and colour. When did symptoms start, how long do they last?

Any triggers?

Does anything help to relieve symptoms?

Breathlessness on exertion is the most common presenting symptom

OCCUPATION

Past and present.

Mining and welding know causes of COPD

HOBBIES

Past and present.

Lots of potential triggers for asthma.

CURRENT and PAST MEDICAL HISTORY

History of chest problems as a child, e.g. asthma, pneumonia, TB etc.

Have they ever been told they have asthma?

Heart conditions.

MEDICATION

Current prescription e.g. B blockers, aspirin, ACE inhibitors, OTC e.g. NSAIDS

ALLERGY/ATOPY

Hay fever/ eczema.

FAMILY HISTORY

Any FH of respiratory problems?

Any atopy?

Heart conditions.

SMOKING STATUS

Current, ex or never smoked

Pack years :> 20 pack years significant for COPD

Number of cigarettes smoked x number of years smoked     = pack years

                                                   20      


DEPRESSION SCEENING

Ask questions - see over - (this may be required for QOF in the near future)

ALCOHOL

Consumption in units/week.

DIET

Poor or good – rich in fruit and vegetables.

Any breathlessness when eating?

EXERCISE

Active or sedentary?

Any limitations on exercise?

Calculate level of breathlessness using MRC Scale (see over) as this is required for QOF. Also included is the new CAT tool and interpretation sheet.

SOCIAL STATUS

Social class, type of housing

Lower social class is more at risk of COPD.

PETS

Dogs, cats, birds – pigeons etc (pigeon fanciers lung)

Any symptoms when in contact with pets?

How long have they had pet?

OBSERVATIONS

How does the patient look when they walk in?

Colour, cyanosed.

Use of accessory muscles, barrel shaped chest.

Pursed lip breathing.

BP and pulse.

Auscultation – breath sounds.

LUNG FUNCTION TESTS

PF - compare with predicted for age and height.

Spirometry requires time; this may not be possible on first appointment, so discuss with patient and give a preparation leaflet, for next appointment.

INVESTIGATIONS

Pulse oximetry

Blood tests

FBC, TFT possibly, ESR, LFT, FBS if weight loss

CXR – if not had recently, may show hyperinflation, enlarged heart, and tumour.

ECG, echo – if indicated, will show IHD/heart failure