Lesson 1Rationale for each question group: linking history elements to common causes of shortness of breath and urgent red flagsExplains how each question group relates to underlying disease processes and common causes of shortness of breath, cough, and chest pain, and how response patterns signal urgent red flags, direct tests, and inform initial treatment plans.
Linking symptom patterns to major diagnosesDistinguishing heart from primary lung causesUsing risk factors to refine pretest probabilityInterpreting red flags for time-critical illnessHistory cues guiding initial investigationsHistory-driven early management decisionsLesson 2Red flag screening: chest pain, fainting, coughing blood, severe shortness of breath, sudden worsening, fever patternTeaches identification of red flag symptoms like pleuritic or effort-related chest pain, fainting, coughing blood, quickly worsening shortness of breath, sepsis signs, and high-risk fever patterns needing urgent action and possible emergency referral.
Characterizing chest pain and pleuritic featuresFainting, near-fainting, and circulatory compromiseAssessing coughing blood volume and clotting riskSevere or rapidly progressive shortness of breath signsFever pattern, shivers, and sepsis indicatorsEscalation thresholds and emergency referralLesson 3Comorbidities and medication review: high blood pressure, heart disease, blood thinners, ACE inhibitors, inhalers, recent antibiotics or steroidsCovers thorough review of co-existing conditions and medications, including heart disease, diabetes, blood thinners, ACE inhibitors, inhalers, and recent antibiotics or steroids, to spot interactions, side effects, and safety concerns.
Key heart-metabolic and kidney comorbiditiesACE inhibitors, beta-blockers, and coughBlood thinners, antiplatelets, and bleeding riskInhaler types, technique, and adherenceRecent antibiotics, steroids, and resistancePolypharmacy, interactions, and deprescribingLesson 4Techniques for focused questioning in time-limited encounters and documenting answers concisely for handover to supervising physicianOffers strategies for focused, patient-centred questioning in short consultations, using open and closed questions, signposting, and summarising, followed by concise, structured notes for safe handover to supervising doctors.
Using open and closed questions effectivelyPrioritising key respiratory history domainsManaging tangents and maintaining rapportSummarising and checking patient understandingSBAR and problem-focused note structureDocumenting red flags and safety nettingLesson 5Social and environmental history: smoking history quantification (pack-years), occupational exposures, recent travel, household contactsFocuses on gathering smoking exposure in pack-years, vaping and cannabis use, work and environmental inhalants, pets, mould, and recent travel or infectious contacts that affect respiratory risk and shape differential diagnosis.
Calculating smoking history and pack-yearsDocumenting vaping, cannabis, and passive smokeOccupational dust, fume, and chemical exposuresHousehold factors: pets, mould, heating, ventilationRecent travel, TB risk, and endemic infectionsClose contacts with respiratory or febrile illnessLesson 6Functional and baseline status: baseline exercise tolerance, daily activities, recent weight change, prior respiratory function testsAddresses evaluation of baseline exercise tolerance, daily activities, sleep, recent weight or appetite change, and previous lung function tests or scans, to assess chronic disease load, functional reserve, and response to past respiratory treatments.
Baseline exercise tolerance and activity levelImpact on daily activities, work, and social participationSleep quality, night-time symptoms, and PNDUnintentional weight loss and appetite changePrior lung function tests, peak flow, and imagingTracking progression and response to therapyLesson 7Family history and allergy history: atopy, premature heart disease, venous thromboembolism predispositionExplores family patterns of asthma, eczema, hay fever, COPD, and early heart disease, plus inherited clotting disorders and VTE history, to refine risk of asthma, PE, and other heart-lung causes of breathlessness.
Family history of asthma, COPD, and atopyEczema, hay fever, and food allergiesPremature heart disease in relativesFamily venous thromboembolism or clotting disordersDrug, latex, and contrast media allergiesEnvironmental allergy patterns and seasonalityLesson 8Systematic exploration of presenting symptoms: onset, duration, progression, character of cough, sputum, triggers, positional factors, exertional limitationCovers structured questioning about respiratory symptoms, including onset, duration, progression, cough and sputum features, triggers, positional change, and effort limits, to differentiate acute from chronic and mild from serious disease.
Clarifying onset, duration, and symptom chronologyCharacterising cough type, timing, and associated painAssessing sputum volume, colour, and coughing bloodIdentifying triggers, irritants, and relieving factorsEvaluating lying flat breathlessness, PND, and positional changeGrading effort-related shortness of breath and activity limitation
