Occupational history

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A detailed history of all occupations and hobbies is essential. Numerous chemicals, moulds, organic dusts and animal proteins can cause asthma and allergic alveolitis. Nonorganic particles such as silica, coal dust and asbestos are important causes of pneumoconiosis and malignant diseases.

TABLE 4.13 Previous history

History

Consequences and Comments

Tuberculosis

May have relapsed, caused bronchiectasis or a lungus ball (aspergilloma) may have formed in an old TB lung cavity

Pneumonia and pleurisy

May have caused bronchiectasis. Recurrent pneumonia and pleurisy may be caused by bronchiectasis, bronchial tumour, aspiration ol oesophageal contents (achalasia of the cardla) or of pharyngeal secretions or vomit (bulbar palsy) and alcoholism. Immunological disorders such as hypogammaglobulinaemia and multiple myeloma should also be considered In patients with recurrent pneumonias

Measles and whooping cough

Can be complicated by pneumonia, particularly in early childhood, and cause 'wheezy bronchitis' or bronchiectasis

Wheezy bronchitis or recurrent bronchitis in childhood

In the past asthma in childhood was often diagnosed as bronchitis. Recurrence of asthma in adults who have a history ol childhood asthma or whee2y bronchitis Is common

Chesl injuries

Traumatic haemothorax can give rise to gross pleural thickening which splints the lung ('frozen chest')

Recent general anaesthetic or loss of consciousness

Inhalation (aspiration) of oropharyngeal secretions or foreign body (e.g. tooth) can give rise to aspiration pneumonia or lung abscess

Pregnancy, recent travel, iilness or surgery

Pulmonary embolism

Chest radiograph

Comparison of a recent chest radiograph with one taken in the past may be of great diagnostic value

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