Patient With Severe Dyspnoea

I met a 47-year-old male, who presented to the secondary to consult for evaluation and management of severe dyspnoea.

His difficulties became apparent about 6 months prior to the consultation, where he began to experience dyspnoea when walking up the stairs and into village, associated with chronic productive cough and cyanosis. 2 days prior to the consultation, his condition further deteriorated with worsening of dyspnoea that was present every day, and progression of chronic cough with increased phlegm production from 2-3 tablespoons to approximately 1 cups daily.

Presentation of a medical history using a structured account

Taking an accurate history is crucial in all conditions to provide appropriate treatment. The starting point was asking the patient if he had any medical problems associated with respiratory system as it was dysnpea that was deadly affecting his quality of life. This included history of asthma, allergies, sinusitis or nasal polyps, previous child hood respiratory infections or other respiratory diseases such as tuberculosis and pneumonia.

He had no known allergies or other previous respiratory problems. Any other medical history including previous hospital admissions, surgeries and comorbidities help to aid differentiation of diagnosis. He had no medical history of cancer, chronic heart failure, coronary artery diseases, or deep vein thrombosis. However, he suffered from angina that was resolved in 2012 after CABG.

In progression of dyspnoea, around 90% of cases are due to cigarette smoking; hence smoking history plays an important role in diagnosis of conditions causing severe dyspnoea. He had history of 70 pack-year smoking and still smoked up to this time. He was not on any medications, had never used recreational drugs, and drinks a moderate amount of alcohol, approximately 8 units per week. Other environmental exposure to smoke was further investigated, asking his occupational history that was unremarkable. Family history was also unremarkable and review of systems was apposite for worsening dyspnoea, chronic cough productive of thick, yellow phlegm and worsening of malaise. No chest pain, edema, or fever reported.

It is also important to ask for social impact that is usually underestimated in patients with dyspnoea, especially those with oxygen supplement.

The housebound patient like Mr.X who was living alone, tend to have social isolation that makes smoking cessation seem impossible. A sense of stigmatization due to severe breathlessness from family and friends results anxiety and depression that is a major source of the morbidity of the illness.

Presentation of the actual or expected examination findings