Introduction
WIPER
Presenting Complaint
ICE: Ideas, Concerns, Expectations
Past Medical History
Medications
Family History
Social History
Taking a comprehensive history from a patient presenting with a cough involves exploring its duration, onset, and characteristics (e.g., dry or productive), as well as associated symptoms such as fever, shortness of breath, or wheezing. Key principles include understanding the context, such as recent infections, exposure to irritants, smoking, or occupational risks, and identifying any exacerbating or alleviating factors. It's crucial to inquire about past medical history, allergies, medications, and family history of respiratory diseases. Additionally, understanding the psychosocial impact of the cough can help tailor management and address patient concerns.
I – Introduce yourself (name and title)
P – Permission, take consent
E – Expose the patient (if necessary)
R – Reposition the patient (if needed)
When did the cough begin?Was the onset sudden or gradual?
When did the cough begin?
Was the onset sudden or gradual?
2. Duration and frequency
How long has the cough been present (acute: <3 weeks,subacute: 3–8 weeks, chronic: >8 weeks)?
How long has the cough been present (acute: <3 weeks,
subacute: 3–8 weeks, chronic: >8 weeks)?
Is it constant or intermittent?
3. Character of the cough:
If productive, describe the sputum (colour, volume,consistency, odour).
If productive, describe the sputum (colour, volume,
Is there haemoptysis (blood-streaked or frank blood)?
Are there any known triggers? (e.g., allergens, smoke, coldair, exercise, lying down).
Are there any known triggers? (e.g., allergens, smoke, cold
air, exercise, lying down).
Shortness of breath, wheezing, chest pain, fever, nightsweats.
Shortness of breath, wheezing, chest pain, fever, night
Heartburn, regurgitation, dysphagia.
Sore throat, nasal congestion, postnasal drip, hoarseness.
Fatigue, weight loss, loss of appetite.
Is the cough worse at any specific time of day (e.g., nocturnal,early morning)?
Is the cough worse at any specific time of day (e.g., nocturnal,
Seasonal variations? Does cold weather make it bad?
What makes the cough worse? (e.g., exertion, lying flat, coldweather
What makes the cough worse? (e.g., exertion, lying flat, cold
Does anything improve the symptom? (e.g., rest, sitting upright, inhalers, oxygen therapy)
What alleviates the cough? (e.g., sitting up, hydration,medication)
What alleviates the cough? (e.g., sitting up, hydration,
How troublesome is the cough on a scale (e.g., mild, moderate,severe)? Ask to rate between 1 (least) to 10 (most)
How troublesome is the cough on a scale (e.g., mild, moderate,
severe)? Ask to rate between 1 (least) to 10 (most)
Ideas: Does the patient think it’s an infection, allergy, or
something serious (e.g., cancer)?
Concerns: Are they worried about the duration or possible
Expectations: Do they hope for reassurance, antibiotics, or
Current medications and recent changes including over the counter drugs.
ACE inhibitors, beta-blockers, or recent antibiotic use.
Over-the-counter remedies for cough.
Recreational drug use (e.g., smoking, vaping)
Family history of asthma, atopy, or other respiratory conditions.
Smoking History: Calculate pack-years history
Alcohol Consumption: How many units per week?
Occupation: Exposure to allergens, dust, or chemicals
Recreational Drugs: Especially cocaine
Lifestyle: Living conditions (e.g., damp housing), pets (potential