Medically Fit For Exams
Medically Fit For Exams

Shortness of breath ( SOB ) history taking


Differential diagnoses




Pulmonary fibrosis

Lung cancer

Heart failure



Acute presentation:

  • PE
  • Pneumothorax
  • Asthma attack
  • Acute coronary syndrome
  • Pneumonia
  • Wash hands and introduce yourself
  • Check the patient’s name and DOB
  • Ask if you can talk to the patient before they see the doctor


History of presenting complaint

  • Ask what has brought the patient in today
  • Ask the patient to tell you more about their breathlessness
  • Ask about onset – how long have you noticed this
    • Very different set of Ddx for acute and chronic presentation
  • Ask about when they get SOB
    • On exertion (COPD, asthma, anaemia, heart failure)
      • How far can they walk before SOB
    • Randomly (unstable angina)
    • Allergic/cold triggers (asthma)
    • In the morning (asthma)
    • In the night (heart failure)
      • Paroxysmal nocturnal dyspnoea
      • Orthopnoea (more pillows)
    • When anxious/stressed (anxiety)
  • Ask if it has stopped them doing anything they would normally do
  • Ask about exacerbating and relieving factors, including inhalers
  • Ask about cough
    • Productive?
      • No (asthma)
      • White/grey (COPD)
      • Pink/frothy (Heart failure)
      • Haemoptysis (Cancer)
      • Green/yellow (pneumonia/infection/infective exacerbation of COPD)
      • Rust (brown) coloured (PE, cancer, TB)
    • How long for?
  • Ask about fever + duration (pneumonia, infection, TB)
  • Ask about weight loss and appetite (cancer)
  • Ask about chest pain
    • While SOB? (ACS, anaemia)
    • Character of pain
      • Sharp/inspiration (PE, pleural effusion/heart failure, pneumothorax)
      • Dull (anaemia, ACS)
  • Further COPD questions
    • Are you a smoker? Pack year history
  • Further asthma questions
    • Do you feel wheezy
    • Is there anything that triggers it?
    • Do you get hayfever or eczema?
    • Early morning/night time coughing
  • Further lung cancer questions
    • Weight loss
    • Fatigue
    • Smoking history
    • Asbestos exposure
  • Heart failure questions
    • As above
    • Leg swelling
    • Fatigue
    • Nocturnal diuresis
  • PE screen
    • Leg/calf swelling
    • Recent travel or periods of sitting still
    • History of cancer
  • MI screen
    • Central crushing chest pain
    • SOB
    • Nausea
    • Sweating/clammy palms
    • Anxiety
  • Summarise what they have told you
  • Systems enquiry if necessary/time


Past medical history

  • Ask about any past or current medical problems
  • Asthma as a child?


Family history

  • Ask about family history of breathing problems, including asthma, and heart problems
  • Ask about any serious illness in the close family


Drug history

  • Ask about current medication, including inhalers
  • Ask about over the counter medications
  • Ask about supplements



  • Ask if the patient has any allergies and what happens


Social history

  • Smoking (should have already asked!)
  • Drinking
  • Ask if they live in a house/bungalow
  • Ask about occupation/past occupation
    • Asbestos
    • Particulates (spray paint, flour, factors, smoke)



  • Ask if the patient has any questions or concerns
  • Ask if there is anything they think you’ve missed out
  • Thank the patient for talking to you




Cough, worse in the night/morning, on exercise, cold air, after triggers

Associated SOB and wheeze/chest tightness

Possibly history of asthma as child, hayfever, eczema, family history


Cough with white/grey sputum

Associated SOB, worse on exertion, history of infective exacerbation

History of smoking



Large amounts of sputum ‘cupfulls’ of varying colour

Frequent infective exacerbation

May have breathlessness and haemoptysis

May have cystic fibrosis

Lung cancer

History of cough with haemoptysis, possible chest pain, weight loss, fatigue, malaise, hoarse voice, stridor, dysphagia


Smoking or asbestos exposure history

Heart failure

SOB, cough with frothy pink sputum, leg swelling, paroxysmal nocturnal dyspnoea, orthopnoea (more pillows), nausea, anorexia, nocturnal diuresis


Fatigue, pallor, chest pain, palpitations, tachycardia, leg pain


Fever, malaise, SOB, sputum production (green, yellow, rusty, possibly occasional blood), pleuritic chest pain

Possible background of COPD or bronchiectasis


Cough, possible haemoptysis, pleuritic chest pain (worse on inspiration and cough), may have signs of DVT, presence of risk factors (recent surgery, bed rest, cancer, immobility, pregnancy, COC/HRT)


SOB, dull/crushing central chest pain, radiation to jaw, neck, shoulder and arm, clammy, anxiety, sudden onset


Cough with haemoptysis, weight loss, low-grade fever and night sweats, may have SOB

Travel history, living in London/Birmingham


SOB history taking.docx
Microsoft Word document [80.7 KB]

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