Respiratory Disease
Respiratory Symptoms
Runny Blocked Nose and Sneezing
Runny nose’ = rhinorrhoea, nasal blockage and sneezing; can be caused by common cold or allergic rhinitis.
Allergic rhinitis: symptoms may be seasonal, following contact with pollen, or perennial, when house-dust mite = important allergen.
Colds: frequent during weekend; if >3 occur, indicates perennial rhinitis rather than viral infection
Nasal secretions: usually thin and runny in rhinitis; thicker and yellow-green in common cold. Nose-bleeds and blood-stained nasal
discharges = common and not as serious as haemoptysis. However, blood-stained nasal discharge + nasal obstruction + pain - may be
presenting feature of a nasal tumour. Total nasal blockage + loss of smell = common feature of nasal polyps
Cough: Most common manifestation of lower respiratory tract disease
Smokers: morning cough + little sputum
Cough = cardinal feature of chronic bronchitis, whilst sputum production of coughing, particularly at night can be symptoms of asthma.
Cough also occurs in asthmatics after mild exertion/ following forced expiration.
Worsening cough = most common presenting symptom of bronchia carcinoma
Bovine cough: explosive character of normal cough is lost when laryngeal paralysis is present, usually resulting from carcinoma of
bonchus infiltrating the left recurrent laryngeal nerve.
Cough may be accompanied by stridor in whooping cough/ presence of laryngeal or tracheal obstruction
Cough may persist in some individuals for many weeks following respiratory tract infection, possibly due to persisting bronchial
inflammation and increased airway responsiveness; may settle with inhaled corticosteroid treatment
Sputum
Healthy, non-smoker: 100mL mucus produced daily; flows at regular pace up the airways, through the larynx and is swallowed; excess
mucus expelled as sputum. Most common cause of excess mucus production = cigarette smoking.
Mucoid sputum = clear and white; can contain black specks due to inhalation of carbon.
Yellow/green sputum = presence of cellular material (bronchial epithelial cells, neutrophils or eosinophil granulocytes); not necessarily
due to infection; eosinophils in the sputum - same appearance seen in asthma.
Bronchiectasis: production of large quantities of yellow/green sputum
Haemoptysis: blood-stained sputum; varies from small streaks of blood - massive bleeding.
- Most common cause: acute infection, particularly in COPD exacerbation; Other common causes: pulmonary infarction, bronchial
carcinoma, tuberculosis
- In lobar pneumonia, sputum is rusty in appearance when blood is present; Pink, frothy sputum seen in pulmonary oedema;
Bronchiectasis: blood often mixed with purulent sputum
- Massive haemoptysis: >200mL blood in 24 hours; usually due to bronchiectasis/ TB
- Uncommon causes: idiopathic pulmonary haemosiderosis, Goodpasture’s syndrome,microscopic polyangiitis, trauma, blood disorders
and benign tumours.
Breathlessness: Assess breathlessness in relationship to the patient’s lifestyle. Moderate degree of breathlessness may be totally
disabling if the patient has to climb many flights of stairs to reach home.
Dyspnoea: sense of awareness of increased respiratory effort - unpleasant. Patients may complain of tightness in the chest (differentiate
from angina); may be due to cardiac or respiratory causes. LV failure (pressure rise in LA and pulmonary capillaries leading to interstitial
and alveolar oedema, increasing amount of respiratory effort required to breathe).
Orthopnoea: form of breathlessness occurring when lying flat; lying flat redistributes blood, resulting in increased central and
pulmonary blood volume. Lying flat causes abdominal contents to push against the diaphragm. Improved: prop up on pillows.
Tachypnoea and Hyperpnoea: refer respectively to increased breathing rate and increased level of ventilation
Hyperventilation: inappropriate over breathing; may occur at rest/ on exertion; results in lowering of the alveolar and arterial PCO2.
Paroxysmal nocturnal dyspnoea: occurs when there is an accumulation of fluid in lungs (pulmonary oedema) at night; as sensory
awareness is depressed during sleep, severe interstitial and alveolar oedema can accumulate. The patient is woken from sleep fighting for
breath. May be relieved by sitting on the side of bed/ getting up. Wheezing, due to bronchial endothelial is common (cardiac asthma);
commonly see cough, productive of frothy/blood tinged sputum.
Wheezing: Common complaint; result of airflow limitation due to any cause; wheezing is not diagnostic of asthma; may be absent in
early stages of disease; may occur in patients with bronchiectasis or COPD
Chest Pain: Most common type of CP = encountered in respiratory disease = localised sharp pain; often referred to as pleuritic; worsened
by deep breathing/cough; can be precisely localised by patient.
Costochrondritis = localised anterior CP may be accompanied by tenderness of a costochondrial junction
Irritation of diaphragmatic pleura: pain in shoulder tip
Central CP radiating to the neck and arms = typical of cardiac origin.
Tracheitis: retrosternal soreness
Invasion of thoracic wall by carcinoma: constant, severe dull pain.
RESPIRATORY DISEASE - SIOBHAN PAGE 1
Respiratory Symptoms
Runny Blocked Nose and Sneezing
Runny nose’ = rhinorrhoea, nasal blockage and sneezing; can be caused by common cold or allergic rhinitis.
Allergic rhinitis: symptoms may be seasonal, following contact with pollen, or perennial, when house-dust mite = important allergen.
Colds: frequent during weekend; if >3 occur, indicates perennial rhinitis rather than viral infection
Nasal secretions: usually thin and runny in rhinitis; thicker and yellow-green in common cold. Nose-bleeds and blood-stained nasal
discharges = common and not as serious as haemoptysis. However, blood-stained nasal discharge + nasal obstruction + pain - may be
presenting feature of a nasal tumour. Total nasal blockage + loss of smell = common feature of nasal polyps
Cough: Most common manifestation of lower respiratory tract disease
Smokers: morning cough + little sputum
Cough = cardinal feature of chronic bronchitis, whilst sputum production of coughing, particularly at night can be symptoms of asthma.
Cough also occurs in asthmatics after mild exertion/ following forced expiration.
Worsening cough = most common presenting symptom of bronchia carcinoma
Bovine cough: explosive character of normal cough is lost when laryngeal paralysis is present, usually resulting from carcinoma of
bonchus infiltrating the left recurrent laryngeal nerve.
Cough may be accompanied by stridor in whooping cough/ presence of laryngeal or tracheal obstruction
Cough may persist in some individuals for many weeks following respiratory tract infection, possibly due to persisting bronchial
inflammation and increased airway responsiveness; may settle with inhaled corticosteroid treatment
Sputum
Healthy, non-smoker: 100mL mucus produced daily; flows at regular pace up the airways, through the larynx and is swallowed; excess
mucus expelled as sputum. Most common cause of excess mucus production = cigarette smoking.
Mucoid sputum = clear and white; can contain black specks due to inhalation of carbon.
Yellow/green sputum = presence of cellular material (bronchial epithelial cells, neutrophils or eosinophil granulocytes); not necessarily
due to infection; eosinophils in the sputum - same appearance seen in asthma.
Bronchiectasis: production of large quantities of yellow/green sputum
Haemoptysis: blood-stained sputum; varies from small streaks of blood - massive bleeding.
- Most common cause: acute infection, particularly in COPD exacerbation; Other common causes: pulmonary infarction, bronchial
carcinoma, tuberculosis
- In lobar pneumonia, sputum is rusty in appearance when blood is present; Pink, frothy sputum seen in pulmonary oedema;
Bronchiectasis: blood often mixed with purulent sputum
- Massive haemoptysis: >200mL blood in 24 hours; usually due to bronchiectasis/ TB
- Uncommon causes: idiopathic pulmonary haemosiderosis, Goodpasture’s syndrome,microscopic polyangiitis, trauma, blood disorders
and benign tumours.
Breathlessness: Assess breathlessness in relationship to the patient’s lifestyle. Moderate degree of breathlessness may be totally
disabling if the patient has to climb many flights of stairs to reach home.
Dyspnoea: sense of awareness of increased respiratory effort - unpleasant. Patients may complain of tightness in the chest (differentiate
from angina); may be due to cardiac or respiratory causes. LV failure (pressure rise in LA and pulmonary capillaries leading to interstitial
and alveolar oedema, increasing amount of respiratory effort required to breathe).
Orthopnoea: form of breathlessness occurring when lying flat; lying flat redistributes blood, resulting in increased central and
pulmonary blood volume. Lying flat causes abdominal contents to push against the diaphragm. Improved: prop up on pillows.
Tachypnoea and Hyperpnoea: refer respectively to increased breathing rate and increased level of ventilation
Hyperventilation: inappropriate over breathing; may occur at rest/ on exertion; results in lowering of the alveolar and arterial PCO2.
Paroxysmal nocturnal dyspnoea: occurs when there is an accumulation of fluid in lungs (pulmonary oedema) at night; as sensory
awareness is depressed during sleep, severe interstitial and alveolar oedema can accumulate. The patient is woken from sleep fighting for
breath. May be relieved by sitting on the side of bed/ getting up. Wheezing, due to bronchial endothelial is common (cardiac asthma);
commonly see cough, productive of frothy/blood tinged sputum.
Wheezing: Common complaint; result of airflow limitation due to any cause; wheezing is not diagnostic of asthma; may be absent in
early stages of disease; may occur in patients with bronchiectasis or COPD
Chest Pain: Most common type of CP = encountered in respiratory disease = localised sharp pain; often referred to as pleuritic; worsened
by deep breathing/cough; can be precisely localised by patient.
Costochrondritis = localised anterior CP may be accompanied by tenderness of a costochondrial junction
Irritation of diaphragmatic pleura: pain in shoulder tip
Central CP radiating to the neck and arms = typical of cardiac origin.
Tracheitis: retrosternal soreness
Invasion of thoracic wall by carcinoma: constant, severe dull pain.
RESPIRATORY DISEASE - SIOBHAN PAGE 1
