• • Weight Loss: Any unintentional weight loss? If so, how much and over what period? (Highly concerning for malignancy or chronic infection like TB).
  • Appetite Changes/Anorexia:
  • Fatigue/Malaise: Any new or worsening tiredness?
• COPD History:
  • Severity: How severe is his COPD usually? (e.g., does he use oxygen at home? How many exacerbations per year?)
  • Medications: What specific inhalers/medications does he currently use for COPD (e.g., salbutamol, ipratropium, tiotropium, inhaled corticosteroids)? Is he compliant? How often does he use his rescue inhaler?
  • Previous Exacerbations: What were his typical symptoms during past COPD exacerbations? How were they treated?
• Smoking History: Confirm 6 years quit, but emphasize the 45 pack-year history as a major risk factor for malignancy. Any exposure to secondhand smoke or other environmental/occupational irritants (e.g., biomass fuel for cooking, dust, chemicals)?
• Past Medical History:
  • Any history of pneumonia, tuberculosis (TB), heart failure, DVT/PE, recent surgery/immobilization, immunosuppression (e.g., HIV, diabetes, chronic steroid use)?
  • Any bleeding disorders or easy bruising?
• Medications (Current): List all, including OTCs, herbal remedies, and supplements. Specifically ask about:
  • Aspirin, NSAIDs (e.g., ibuprofen, diclofenac).
  • Anticoagulants (e.g., warfarin, apixaban, rivaroxaban) or antiplatelet agents (e.g., clopidogrel) – could explain bleeding.
  • ACE inhibitors (for blood pressure) – known to cause dry cough, but rarely hemoptysis.
• Travel/Exposure History: Recent travel? Exposure to sick contacts (especially with prolonged cough, TB exposure)?
• Social History: Occupation, living situation, any history of alcohol or drug use.

2) Additional Objective Findings

Beyond basic vitals, a focused physical examination is crucial:

• General Appearance: Nutritional status (cachexia is highly concerning), level of consciousness, signs of respiratory distress (pursed-lip breathing, use of accessory muscles, nasal flaring, intercostal/supraclavicular retractions), pallor, cyanosis (central or peripheral).
• Vital Signs:
  • Oxygen Saturation (SpO2): Absolutely critical. On room air first, then with supplemental oxygen if needed.
  • Temperature: Any fever?
  • Respiratory Rate: Is RR 22 his baseline or elevated? (Normal is 12-20, 22 is elevated).
  • Blood Pressure & Heart Rate: Re-check. Assess for orthostatic changes if volume depletion is suspected.
• HEENT:
  • Nares: Inspect for active bleeding or dried blood (r/o epistaxis).
  • Oropharynx: Inspect tonsils, posterior pharynx for inflammation, post-nasal drip, or bleeding source (r/o gingival bleeding, pharyngeal lesion).