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History Taking for Wheeze: Case Presentation Guide
A structured and comprehensive history is essential for evaluating a patient with wheeze, especially in the Indian context where asthma, infections, and environmental exposures are common.
1. Patient Demographics and Background
Name, age, gender, occupation, and place of residence..
2. Presenting Complaint
Main complaint: “Wheeze” (describe as a whistling, musical sound during breathing).
Duration, onset (sudden/gradual), and frequency (episodic/persistent).
3. History of Present Illness
Characterization of Wheeze:
Timing: Day/night, seasonal variation, relation to exercise, allergens, or infections.
Nature: Monophonic or polyphonic, associated with specific triggers.
Associated Symptoms:
Cough (dry/productive, duration, sputum characteristics)
Shortness of breath (dyspnea), chest tightness, stridor
Fever, nasal symptoms, sore throat
Precipitating/Relieving Factors:
Exposure to dust, smoke, cold air, pets, pollen, exercise, or infections
Response to medications (e.g., bronchodilators)
Severity and Impact:
Interference with sleep, daily activities, or school/work attendance
Need for hospitalization or emergency visits
4. Past Medical and Surgical History
Previous episodes of wheeze, asthma, or respiratory illnesses.
History of allergies (nasal, skin, eye), eczema, or atopy.
Hospitalizations, ICU admissions, or intubations for respiratory distress.
Any surgeries, especially thoracic or ENT.
Relevant exposures (e.g., dust, smoke, pets, occupational hazards)
Drug and Allergy History
Current and past medications (inhalers, bronchodilators, steroids, antibiotics).
Drug allergies or adverse reactions.
7. Family History
Asthma, atopy, allergies, or other respiratory diseases in family members6.
8.Personal History
Smoking history (active or passive exposure)3.
Alcohol use.
Occupational exposure to dust, chemicals, or fumes.
9.Socioeconomic history
Living conditions (crowding, dampness, pets, air pollution).
Socioeconomic status.
8. Systemic Review
Symptoms suggestive of other organ involvement (skin rashes, joint pain, GI symptoms).
Weight loss, appetite changes, general well-being.
Summary of Key Points
Always clarify onset, duration, frequency, and triggers of wheeze.
Ask about associated symptoms and impact on daily life.
Elicit risk factors (allergies, family history, exposures).
Assess for severity and previous complications.
Patient Profile
Name: Master Aarav Singh
Age/Sex: 8-year-old male
Residence: Urban, Delhi
Schooling : Class 3, attends school regularly
Date of admission :
Date of examination :
Informant :
Presenting Complaints
Whistling sound from chest (wheeze) for 4 days
Cough for 4 days
Shortness of breath for 2 days
History of Present Illness
Child was apparently well 4 days ago when he developed a dry cough, which became productive with scanty white sputum after 2 days.
Parents noticed a whistling sound from the chest, more pronounced during expiration, especially at night and early morning.
Shortness of breath developed 2 days ago, initially on exertion, now also at rest.
Symptoms worsened after playing outside and exposure to dust.
No history of fever, chest pain, hemoptysis, or vomiting.
No history of similar complaints in the past.
No history of foreign body aspiration, choking, or recent travel.
No nocturnal awakening due to cough or breathlessness.
No history of contact with tuberculosis
Review of Systems
No weight loss, appetite loss, or night sweats.
No skin rashes, joint pain, or other systemic symptoms.
Past Medical and Surgical History
History of previous wheezing episodes.
Previous hospitalizations 2 times in last 1 year for similar complaints.
No known chronic illnesses (asthma, congenital heart disease).
No prior surgeries.
Family History
Father has a history of bronchial asthma since childhood.
No family history of tuberculosis or other chronic lung diseases.
Personal History
Non-smoker household; no passive smoke exposure.
Lives in a house near a busy road (exposure to vehicle smoke).
No pets at home.
No exposure to biomass fuel.
Attends school regularly; no recent absenteeism.
Drug History
Patient is on regular inhalers for past 1 year, now default for 2 days
Socioeconomic History
Pucca house
4 membered family
Drinks boiled water
No overcrowding
Summary of Key Findings
8-year-old boy with acute onset wheeze, cough, and breathlessness, precipitated by dust exposure, with a positive family history of asthma and environmental risk factors (vehicle smoke exposure).
No evidence of infection, foreign body, or systemic illness.
Provisional Diagnosis
Acute exacerbation of bronchial asthma (first episode likely, considering family history and triggers).
Differential Diagnosis
Bronchiolitis (less likely at this age)
Allergic bronchitis
Lower respiratory tract infection (atypical, as no fever)
Foreign body aspiration (unlikely as no choking episode)
Case of wheeze for a 65 year old male
Patient Profile
Name: Mr. Rajendra Prasad
Age/Sex: 65-year-old male
Occupation: Retired school teacher
Residence: Urban, Patna, Bihar
Date of admission :
Date of Examination :
Informant : Patients's wife
Presenting Complaints
Whistling sound from chest (wheeze) for 3 weeks
Cough for 3 weeks
Shortness of breath for 2 weeks
History of Present Illness
Patient was apparently well 3 weeks ago when he developed a cough, initially dry, now productive with scanty whitish sputum.
Noticed a whistling sound from the chest, more pronounced during expiration and especially at night and early morning.
Shortness of breath developed 2 weeks ago, initially on exertion, now also at rest.
No history of fever, chest pain, hemoptysis, or orthopnea.
Symptoms worsened with exposure to dust and cold air.
Reports similar but milder episodes over the past 5 years, usually during winters or after respiratory infections, but never required hospitalization.
No history of childhood asthma, but has a history of progressive worsening of breathlessness and wheeze over the last few years.
No history of tuberculosis, recent travel, or foreign body aspiration.
No significant weight loss or loss of appetite.
Review of Systems
No paroxysmal nocturnal dyspnea, orthopnea, or pedal edema.
No symptoms suggestive of cardiac failure.
No gastrointestinal or neurological complaints.
Past Medical and Surgical History
Known case of hypertension for 10 years, on regular medication.
Diagnosed with COPD 6 years ago.
No previous hospitalizations for respiratory failure.
No prior surgeries.
Family History
No family history of asthma, COPD, or tuberculosis.
Personal History
Non-smoker, but significant exposure to biomass fuel (firewood) during childhood and early adult life.
No alcohol use.
No pets at home.
Retired, spends most time at home.
Drug and Allergy History
On inhaled bronchodilators (irregular use), oral antihypertensives.
No known drug allergies.
No history of atopy, eczema, or allergic rhinitis.
Socioeconomic History
Lives in a well-ventilated house near a busy road (vehicular pollution).
2 membered house
No overcrowing
Use smokeless stove for cooking
Summary of Key Findings
65-year-old male with chronic cough, progressive wheeze, and breathlessness, with a background of COPD, history of biomass fuel exposure, and environmental risk factors (vehicular pollution).
No evidence of acute infection, cardiac failure, or malignancy based on history.
Provisional Diagnosis
Acute exacerbation of chronic obstructive pulmonary disease (COPD) with wheeze.
Differential Diagnosis
Asthma-COPD overlap syndrome (ACO)
Bronchial asthma (late onset, less likely without atopy or childhood history)
Endobronchial obstruction (e.g., malignancy, especially if new onset or unilateral wheeze)
Lower respiratory tract infection (if new symptoms or fever develops)
Viva Questions and Answers: Wheeze
1. What is a wheeze?
Answer:
A wheeze is a continuous, musical, high-pitched sound produced during breathing, typically heard more during expiration than inspiration, caused by airflow through narrowed or obstructed airways.
2. What are the common causes of wheeze in adults?
Answer:
Bronchial asthma
Chronic obstructive pulmonary disease (COPD)
Acute bronchitis
Cardiac asthma (left heart failure)
Bronchiectasis
Foreign body aspiration (rare in adults)
Endobronchial tumors or obstruction.
3. How do you differentiate between wheeze due to asthma and COPD?
Answer:
Asthma: Usually has a history of atopy/allergy, episodic symptoms, significant diurnal variation, and is often reversible with bronchodilators.
COPD: Associated with chronic productive cough, progressive and persistent symptoms, history of smoking or biomass exposure, and less reversibility with bronchodilators.
4. What is the pathophysiology of wheeze?
Answer:
Wheeze is produced due to turbulent airflow through narrowed airways, which may be caused by bronchospasm, mucosal edema, increased secretions, or airway obstruction.
5. What are the important points to elicit in the history of a patient with wheeze?
Answer:
Onset, duration, and frequency of wheeze
Precipitating/relieving factors (allergens, exercise, infections)
Associated symptoms (cough, breathlessness, chest tightness, fever)
Past history of similar episodes, atopy, or allergies
Family history of asthma or allergies
Smoking and occupational exposure
Response to bronchodilators.
6. How do you clinically assess the severity of an acute wheeze episode?
Answer:
Degree of breathlessness and ability to speak
Use of accessory muscles of respiration
Presence of cyanosis
Respiratory rate and heart rate
Oxygen saturation (SpO₂).
7. What are the complications of untreated severe wheeze?
Answer:
Respiratory failure
Hypoxemia and hypercapnia
Pneumothorax (rare, due to barotrauma)
Cardiac arrhythmias
Death in extreme cases.
8. What investigations would you order in a patient presenting with wheeze?
Answer:
Peak expiratory flow rate (PEFR)
Spirometry (to assess reversibility)
Chest X-ray
Complete blood count
Sputum examination (if productive cough)
Arterial blood gas (in severe cases).
9. How do you manage an acute episode of wheeze?
Answer:
Inhaled short-acting bronchodilators (e.g., salbutamol)
Oxygen supplementation if hypoxic
Systemic corticosteroids (oral or IV)
Anticholinergics (e.g., ipratropium)
Treat underlying cause (e.g., infection, allergen avoidance).
10. What are the indications for hospital admission in a patient with wheeze?
Answer:
Severe breathlessness or inability to speak
SpO₂ < 92% on room air
Poor response to initial therapy
Presence of comorbidities (e.g., cardiac disease, COPD)
History of previous severe attacks or ICU admission