History

The history should focus on establishing the diagnosis of CPO as well identifying any precipitating event.  Previous episodes of CPO, orthopnoea or PND together with any historical factors that could point towards a precipitating cause should be elicited.

Table 1 lists typical historical features of patients presenting with respiratory distress to help distinguish CPO from other causes.

Table 1: Distinguishing CPO from other pathologies
Symptom CPO COPD Pneumonia PE

Precipitating

Cause e.g. ACS

SOB ++ + + +
Cough

+

Pink frothy

sputum

+

Dry

cough

+

Green

sputum

Haemoptysis
Chest pain + + +
Palpitations + + + ++
Fever + ++
Sweating ++ + + +
Acuity + + +
Nocturnal ++