The main symptoms of pulmonary disease are the following:
•Cough
•Sputum Production
•Hemoptysis (coughing up blood)
•Dyspnea (shortness of breath)
•Wheezing
•Cyanosis (bluish discoloration of the skin)
•Chest pain
COUGH
DRY |
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PRODUCTIVE |
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OF SPUTUM |
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•How long has the cough been present?
•Is the cough worse at any time of day or night?
•Is the cough aggravated by anything
Descriptors of Coughing
Description |
Possible causes |
Dry, hacking |
Viral infections, interstitial lung disease, |
|
tumor, allergies, anxiety |
Chronic, productive |
Bronchiectasis, chronic bronchitis, |
|
abscess, bacterial pneumonia, tuberculosis |
Wheezing |
Bronchospasm, asthma, allergies, |
|
congestive heart failure |
Barking |
Epiglottal disease (e.g., croup) |
Stridor |
Tracheal obstruction |
Morning |
Smoking |
Nocturnal |
Postnasal drip, congestive heart failure |
Associated with |
Neuromuscular disease of the upper |
eating or drinking |
esophagus |
Inadequate |
Debility, weakness |
Clinical features of sputum
White or grey
•Smoking
•Simple chronic bronchitis
•Asthma
Yellow or green
•Acute bronchitis
•Acute on chronic bronchitis
•Asthma
•Bronchiectasis
•Cystic fibrosis
Frothy, blood-streaked
• Pulmonary oedema
Causes of haemoptysis
Common
•Infection including bronchietasis
•Bronchial carcinoma
•Tuberculosis
•Pulmonary embolism and infarction
•No cause found
Uncommon
•Mitral stenosis and left ventricular failure
•Bronchial adenoma
•Idiopathic pulmonary haemosiderosis
•Anticoagulation
Characteristics Distinguishing Hemoptysis from Hematemesis
Features |
Hemoptysis |
Hematemesis |
Prodrome |
Coughing |
Nausea and vomiting |
Past history |
Possible history of |
Possible history of |
|
cardiopulmonary |
gastrointestinal disease |
Appearance |
Frothy |
Not frothy |
Color |
Bright red |
Dark red, brown, or “coffee |
|
|
grounds” |
Manisfestation |
Mixed with pus |
Mixed with food |
Associated symptoms |
Dyspnea |
Nausea |
Pointers to the significance of an episode of haemoptysis
Probably serious
•Middle-aged or elderly
•Spontaneous
•Previous or current smoker
•Recurrent
•Large ammount
Probably not serious
•Young
•Recent infection
•Never smoked
•Single episode
•Small amount - if single episode
BREATHLESSNESS
•Breathlessness inappropriate to the level of physical exertion or occurring at rest is called dyspnoe
•Mechanisms are complex and not fully understood
–Hypoxia- lowered blood oxygen tension
–Hypercapnia –raised blood carbon dioxide tension
Disorders
Some causes of breathlessness
Control and movement of the chest wall and pleura
•Hyperventilation syndrome
•Hypothalamic lesions
•Neuromuscular disease
•Kyphoscoliosis
•Ankylosing spondylitis
•Pleural effusion and thickening
•Bilateral diaphragm paralysis
Diseases of the lungs
•Airways diseases
Chronic bronchitis and emphysema
Asthma
Bronchiectasis
Cystic fibrosis
•Parenchimal disease
Pneumonia
Cryptogenic fibrosing alveolitis
Extrinsic allergic alveolitis
Primary and secondary tumour
Sarcoidosis
Pneumothorax
Pulmonary oedema
•Reduced blood supply
Pulmonary embolism
Duration of breathless
Immediate minutes
•Pulmonary embolism
•Pneumothorax
•Pulmonary oedema
•Asthma
Short (hours to days)
•Pulmonary oedema
•Pneumonia
•Asthma
•Pleural effusion
•Anaemia
Long (weeks to years)
•Chronic airflow limitation
•Cryptogenic fibrosing alveolitis
•Anaemia