• Is the patient known to suffer from an underlying cardiopulmonary disease, for example asthma, COPD, heart disease?
• Are there features to suggest infection, for example fever, cough, purulent sputum or increase in sputum volume?
• Is there chest pain (pleuritic or non-pleuritic)?
• What is the rate of onset of the presentation? Is it acute, sub-acute or chronic?

Background

• Usual functional status
• Careful drug history, for example opiates, benzodiazepines, respiratory or cardiac medications
• Social history: occupation, smoking, alcohol excess

Examination

• Drowsiness (GCS)
• Tachypnoea
• Cyanosis
• Tachycardia or bradycardia
• Blood pressure
• Tremor, bounding pulse, flap/asterixis
• Raised JVP, peripheral oedema
• Chest wall abnormalities (kyphoscoliosis, flail chest post trauma)
• Paradoxical movement of the diaphragm
• Chest examination:
  • Wheeze (consider: asthma, COPD, heart failure)
  • Fine inspiratory crackles (consider: heart failure, fibrosis)
  • Coarse crackles (consider: bronchiectasis, pneumonia)
  • Bronchial breathing (consider: pneumonia)
  • Dull percussion note, reduced air entry (consider: pleural effusion)
  • Hyper-resonant percussion note, reduced air entry (consider: pneumothorax)
  • Peak expiratory flow (if patient is able to perform)
• Neurological examination: are there features of a chronic neurological disease? Are there focal neurological features?