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Medical History and Physical Examination for Lung Disorders

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Medical History

A doctor first asks the person about symptoms. Chest tightness or pain, shortness of breath (dyspnea) either at rest or during exertion, cough, coughing up of sputum or blood (hemoptysis), and wheezing may indicate a lung or airway disorder. Other, more general symptoms, such as fever, weakness, fatigue, or a general feeling of illness or discomfort (malaise), sometimes also reflect a lung or airway disorder.

Next, the doctor asks the person about

  • Past lung disorders and infections

  • Previous exposure to chemicals, dusts, molds, or animals

  • Use of drugs, alcohol, and tobacco

  • Home and work environments

  • Travels

  • Recreational activities

A doctor asks whether family members have had lung or airway disorders or any other disorders that may affect the lungs or airways (such as clotting and generalized inflammatory disorders). The doctor also asks about other common symptoms and other medical disorders, even those that do not seem related to the respiratory system.

Physical Examination

During the physical examination, a doctor notes the person's weight and overall appearance. The person's general mood and feeling of well-being, which also may be affected by a lung or airway disorder, are also noted. A doctor may ask a person to walk around or climb a flight of stairs to see if either activity causes shortness of breath. These activities may be done while measuring pulse oximetry, which is a way to quantify the amount of oxygen in the blood. Use of pulse oximetry can allow the doctor to determine if blood oxygen levels are low or if they decrease during exertion.

Assessing skin color is important because paleness (pallor) may indicate anemia or poor blood flow, and a bluish discoloration (cyanosis) may indicate an inadequate amount of oxygen in the blood. Fingers are examined for clubbing (see Figure: Recognizing Finger Clubbing).

A doctor observes the chest to determine if the breathing rate and movements are normal. Using a stethoscope, a doctor listens to the breath sounds to determine whether airflow is normal or obstructed and whether the lungs contain fluid. By tapping (percussing) the chest, a doctor can often determine if the lungs are filled with air or collapsed and if the space around the lungs contains fluid. In addition to examination of the chest, a complete physical examination may be needed, because disorders of the lungs may affect other parts of the body. Additionally, for some disorders not related to the lungs, the first symptoms may suggest a lung problem. For example, shortness of breath might reflect an abnormality of the kidneys or heart, and pneumonia might reflect an abnormality of the immune system.