History-taking
CPSA · Focused history · Respiratory
Breathlessness
Breathlessness spans cardiac, respiratory and other causes. Time course, associated symptoms and the cardiac/respiratory screen point to the diagnosis.
Focused questions
Characterise
- Onset (sudden vs gradual), duration, exertional tolerance (how far can you walk?), diurnal variation, positional (orthopnoea, PND)
Associated symptoms
- Cough, sputum, haemoptysis, wheeze, chest pain, fever
- Cardiac: orthopnoea, PND, ankle swelling, palpitations
Screen causes
- Asthma/COPD: wheeze, triggers, smoking, diurnal
- Heart failure: orthopnoea, PND, oedema
- PE: sudden onset, pleuritic, VTE risk
- Pneumonia: fever, productive cough; anaemia; anxiety
Differentials to screen
Asthma / COPD exacerbationWheeze, known diagnosis, triggers, smoking history
Heart failureOrthopnoea, PND, ankle oedema, cardiac history
Pulmonary embolismSudden onset, pleuritic pain, VTE risk factors
PneumoniaFever, productive cough, focal signs
AnaemiaGradual, fatigue, pallor, no chest signs
Red flags — exclude these
- Sudden severe breathlessness (PE, pneumothorax)
- Silent chest / exhaustion in asthma
- Haemoptysis with weight loss (malignancy)
- Stridor (upper airway obstruction)
OSCE tips
- Quantify with exercise tolerance and orthopnoea (how many pillows).
- Separate cardiac (orthopnoea/PND/oedema) from respiratory (wheeze/cough/sputum) early.
- Always screen for PE risk factors in acute breathlessness.