Horner's syndrome (possible apical lung cancer). General appearance - eg, Cushingoid as a result of long-term use of steroids. Hypertrophic pulmonary osteoarthropathy. A tremor may indicate carbon dioxide retention. A large pneumothorax or a tension pneumothorax can cause pulsus paradoxus. Lung cancer can cause atrial fibrillation. Radial pulse: tachycardia suggests significant respiratory difficulty or marked overuse of a beta agonist. Note whether there are any indicators of recent weight loss - eg, sunken cheeks. 
Note whether the patient appears to be pyrexial (check their temperature).Evidence of other respiratory symptoms - eg, cough, audible wheeze.
#VESICULAR BREATH SOUNDS YOUTUBE FULL#
Evidence of respiratory distress at rest or when walking - eg, obvious breathlessness, talking in short phrases rather than full sentences, use of accessory muscles, exhalation with pursed lips. Atopic diseases such as asthma, hay fever and eczema. Infectious diseases such as tuberculosis (remember high-risk groups). Respiratory diseases with a genetic component - eg, cystic fibrosis, emphysema (alpha-1-antitrypsin deficiency). Sexual history may be relevant to risk of HIV and AIDS. Smoking history should detail, for example, the type and number of cigarettes smoked currently and in the past. Lifestyle and alcohol consumption are also very relevant to respiratory diseases. Hobbies and pets may also be responsible for respiratory disease (refer to the article on hypersensitivity pneumonitis). See the separate Occupational Asthma, Industrial Dust Diseases, Asbestos-related Diseases, Hypersensitivity Pneumonitis and Sick Building Syndrome articles. An occupational history may be very important in respiratory disease. Other drugs which may have relevance in respiratory disease - eg, angiotensin-converting enzyme (ACE) inhibitors (cough).Īsk about all allergies including, for example, food, inhaled allergens and drugs. Use of steroids (some measure of severity in asthma). Use of inhalers (assess compliance and technique). Neuromuscular diseases may cause respiratory symptoms, particularly dyspnoea. Rheumatoid arthritis and other connective tissue diseases may cause respiratory symptoms. Severe anaemia may cause breathlessness. Establish whether there are any indications of heart failure or coronary heart disease. Heart disease may cause respiratory symptoms. Upper gastrointestinal symptoms: gastro-oesophageal reflux is a common cause of chronic cough. Significant loss of weight may well be indicative of serious illness - eg, malignancy or tuberculosis. It suggests that the disease is having a significant effect on well-being. 
Loss of appetite is a common feature whenever people are unwell.NB: severe asthma may cause a silent chest with no wheeze. Wheeze (see the separate Asthma and Wheezing in Children articles).Cough and sputum (see the separate Chronic Persistent Cough in Adults and Chronic Cough in Children articles).Dyspnoea (see the separate Breathlessness article).
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