MMRC Dyspnoea Scale Runny Blocked Nose and Sneezing
Grade 0: not troubled by SOB except on strenuous exercise Runny nose’ = rhinorrhoea, nasal blockage and sneezing; can be caused by comm
Grade 1: SOB when hurrying on level/ walking slightly uphill Allergic rhiniFs: symptoms may be seasonal, following contact with pollen, or pe
Grade 2: walks slower than people of same age on the level due to SOB, or has to stop for mite = important allergen. Colds: frequent during weekend; if >3 occur, indicate
breath when walking at own pace on the level than viral infecFon
Grade 3: stops for breath a>er walking about 100m, or a>er a few min on level Nasal secreFons: usually thin and runny in rhiniFs; thicker and yellow-green in c
Grade 4: too breathless to leave house, or SOB when dressing/ undressing and blood-stained nasal discharges = common and not as serious as haemoptysi
nasal discharge + nasal obstrucFon + pain - may be presenFng feature of a nasa
+ loss of smell = common feature of nasal polyps
Cough: Most common manifestaFon of lower respiratory tract disease
Smokers: morning cough + liTle sputum
Cough = cardinal feature of chronic bronchiFs, whilst sputum producFon of coughing, Sputum
parFcularly at night can be symptoms of asthma. Cough also occurs in asthmaFcs a>er mild Healthy, non-smoker: 100mL mucus produced daily; flows at regular pace up air
exerFon/ following forced expiraFon. swallowed; excess mucus expelled as sputum. Most common cause of excess m
Worsening cough = most common presenFng symptom of bronchia carcinoma smoking.
Bovine cough: explosive character of normal cough is lost when laryngeal paralysis is present, Mucoid sputum = clear and white; can contain black specks due to inhalaFon of
usually resulFng from carcinoma of bonchus infiltraFng the le> recurrent laryngeal nerve. Yellow/green sputum = presence of cellular material (bronchial epithelial cells, n
Cough may be accomp by stridor in whooping cough/ laryngeal or tracheal obstrucFon granulocytes); not necessarily due to infecFon; eosinophils in the sputum - same
Cough may persist in some individuals for many weeks following RTI, possibly due to persisFng Bronchiectasis: producFon of large quanFFes of yellow/green sputum
bronchial inflammaFon and inc airway responsiveness; may seTle with inhaled corFcosteroids Haemoptysis: blood-stained sputum; varies from small streaks of blood - massiv
acute infxn, esp in COPD exacerbaFon; Other common causes: pulm infarcFon,
In lobar pneumonia, sputum rusty in appearance when blood is present; Pink, fr
Breathlessness: Assess SOB in relaFonship to pt’s lifestyle. Moderate degree of SOB may be pulmonary oedema;
totally disabling if pt has to climb many flights of stairs to reach home. Bronchiectasis: blood o>en mixed with purulent sputum. Massive haemoptysis:
Dyspnoea: sense of awareness of inc resp effort - unpleasant. Pts may c/o Fghtness in chest usually due to bronchiectasis/ TB. Uncommon causes: idiopathic pulmonary hae
(differenFate from angina); may be due to cardiac or resp causes. LV failure (pressure rise in LA syndrome,microscopic polyangiiFs, trauma, blood disorders and benign tumour
and pulm capillaries àintersFFal and alveolar oedema, inc resp effort req to breathe).
Orthopnoea: form of breathlessness occurring when lying flat; lying flat redistributes blood, à Mucoid sputum: clear, thin, frothy
inc central and pulmonary blood vol. Lying flat causes abdominal contents to push against the Purulent: yellow/green; thick, viscid, offensive odour (pus)
diaphragm. Improved: prop up on pillows. Muco-purulent: both mucoid + purulent
Tachypnoea and Hyperpnoea: refer respecFvely to inc resp rate and inc level of venFlaFon Haemoptysis: bright red/ frothy blood
HypervenLlaLon: inappropriate over breathing; may occur at rest/ on exerFon; results in Current jelly: blood clots
lowering of the alveolar and arterial PCO2. Rusty: mucupurulent with red Fnge
Paroxysmal nocturnal dyspnoea: accumulaFon of fluid in lungs (pulmonary oedema) at night; Prune juice: dark brown, mucopurulent, offensive odour
as sensory awareness is depressed during sleep, severe intersFFal and alveolar oedema can Blood streaked
accumulate. Pt is woken from sleep fighFng for breath. May be relieved by sieng on the side of Pink/ frothy: pink + frothy; acute pulm oedema
bed/ geeng up. Wheezing, due to bronchial endothelial is common (cardiac asthma);
commonly see cough, producFve of frothy/blood Fnged sputum.
Air PolluLon
Atmospheric air polluFon due to burning of coal for energy and heat.
Chest Pain: Most common type of CP = encountered in resp disease = localised sharp pain; Primary pollutants: nitrogen oxides (NO and NO2), diesel parFculates, polyarom
o>en referred to as pleuriFc; worsened by deep breathing/cough; can be precisely localised by secondary pollutant ozone (O3) generated by photochemical reacFons in the at
paFent. Epidemiology: Black smoke and SO2 causes excess deaths from respiratory and
CostochrondriFs = localised anterior CP may be accompanied by tenderness of a costochondrial older populaFons; and symptoms of bronchiFs in children.
juncFon PolluFon from motor vehicles causes: increased deaths from respiratory and ca
IrritaFon of diaphragmaFc pleura: pain in shoulder Fp (parFculates <10um diameter; PM10); increased respiratory symptoms and red
Central CP radiaFng to the neck and arms = typical of cardiac origin. TracheiFs: retrosternal and younger adults (SO2, NO2, O3, PM10). Frequently, lag of 1-2 days between
soreness disease effects. Increased lung cancer: polyaromaFc hydrocarbons
Invasion of thoracic wall by carcinoma: constant, severe dull pain. Management: AsthmaFcs advised not to exercise outdoors during periods of po
increase their anF- inflammatory medicaFon (i.e. inhaled sodium cromoglicate/
corFcosteroids)
Wheezing: Common complaint; result of airflow limitaFon due to any cause; wheezing is not Short- and long-term measures are required to reduce air polluFon parFcularly
diagnosFc of asthma; may be absent in early stages of disease; may occur in paFents with motor e ngine efficiency, catalyFc converters, diesel parFculate traps and decre
bronchiectasis or COPD trucks.
Signs Of Respiratory Distress Smoking
Physical examinaLon: InspecFon; PalpaFon; Percussion; AuscultaFon. Prevalence: general decline in prevalence of smoking in men but not women; ci
InspecLon of hands: Peripheral cyanosis (blue Linger Fps); Flapping tremor (CO2 retenFon); common between 16-24 years.
Clubbing (increased curvature of nail) [Respiratory causes of Linger clubbing: bronchial Toxic Effects: Organic smoke contains polycyclic aromaFc hydrocarbons and nitr
carcinoma, bronchiectasis, empyema, lung abscess, lung Librosis]; NicoFne stains carcinogens and mutagens in animals). Causes release of enzymes from neutrop
InspecLon of Neck: Lymph Nodes (cervical) – done from back; Deviated trachea macrophages that are capable of destroying elasFn and leads to lung damage; p
InspecLon and appearance of chest: Tachypnoea (fast breathing); Scars; Skin metastasis; permeability increases even in symptomless cigareTe smokers, correlaFng with
Barrel chested (apex diameter similar to lateral side): chronic respiratory disorders e.g. COPD; in blood. Altered permeability possible allows earlier access to carcinogens.
Pectus excavarFum (sunken chest); Pectus carinatum (sFcking out sternum) The dangers: cigareTe smoke = addicFve; nicoFne - persistence, advantageous
InspecLon – Breathing Rate: Breathing paTern: shallow, Kussmaul, Cheyne-stokes, pursed lips Sputum producFon and airflow limitaFon inc with daily cigareTe consumpFon;
(COPD), orthopnoea (SOB on lying down; require propping up with pillows) part due to high levels of carboxyHb in bronchiFs paFents.
Chest wall movements: Expansion general/unilateral; Paradoxical: flail, intercostal recession, Smoking and asbestos exposures = synergisFc in producing bronchial carcinoma
indrawn ribs; Use of accessory muscles. asbestos exposures 5-8x that of non-smokers exposed to asbestos.
Scoliosis and kyphosis can influence the lungs (reduce expansion and bent forwards Environmental tobacco smoke = passive smoking; causes more frequent + more
respecFvely) Chest PalpaLon: place hand on paFent’s chest and check paFent’s chest is children; poss increases number of asthma cases. Associated with small but defi
expanding on both sides Smoking CessaLon: Smoking withdrawal clinics = 80% success rates in the first m
Barrel Chest: fail to see chest expansion = IndicaFve of COPD; chest already expanded 15-20% remain absFnent. NicoFne likely to be no beTer than verbal advice. Nico
Chest percussion: TympaniFc: hollow viscus placebo. Chest symptoms need to be severe to stop paFents from smoking.
Hyperresonant: PNTX; Resonant: normal lung; Impaired: consolidaFon/ collapse/ fibrosis; Dull: Pharmacological support: amfebutamone/ bupaprion (NAdr and DA re-uptake in
consolidaFon/ collapse/ fibrosis; Stony dull: pleural effusion
Chest AuscultaLon: Normal breath sounds are vesicular. General Dangers: Lung cancer, COPD, Carcinoma of the oesophagus, ischaemic
Decreased air entry: Generalised: emphysema; Localised: bronchial obstrucFon by tumour vascular disease, bladder cancer, increased abnormal spermatozoa, memory pro
(Tumour à bronchial obstrucFon); Thick chest wall; Pleural effusion/thickening Passive smoking dangers: Risk of asthma, pneumonia and bronchiFs in infants o
Added Sounds and SOB in smokers and non-smokers with COPD and asthma; increased risk of c
Ronchi (wheezes): Musical noise produced by air passing through narrowed airways e.g. Maternal smoking dangers: Decreased birthweight of infant; increased fetal and
Grade 0: not troubled by SOB except on strenuous exercise Runny nose’ = rhinorrhoea, nasal blockage and sneezing; can be caused by comm
Grade 1: SOB when hurrying on level/ walking slightly uphill Allergic rhiniFs: symptoms may be seasonal, following contact with pollen, or pe
Grade 2: walks slower than people of same age on the level due to SOB, or has to stop for mite = important allergen. Colds: frequent during weekend; if >3 occur, indicate
breath when walking at own pace on the level than viral infecFon
Grade 3: stops for breath a>er walking about 100m, or a>er a few min on level Nasal secreFons: usually thin and runny in rhiniFs; thicker and yellow-green in c
Grade 4: too breathless to leave house, or SOB when dressing/ undressing and blood-stained nasal discharges = common and not as serious as haemoptysi
nasal discharge + nasal obstrucFon + pain - may be presenFng feature of a nasa
+ loss of smell = common feature of nasal polyps
Cough: Most common manifestaFon of lower respiratory tract disease
Smokers: morning cough + liTle sputum
Cough = cardinal feature of chronic bronchiFs, whilst sputum producFon of coughing, Sputum
parFcularly at night can be symptoms of asthma. Cough also occurs in asthmaFcs a>er mild Healthy, non-smoker: 100mL mucus produced daily; flows at regular pace up air
exerFon/ following forced expiraFon. swallowed; excess mucus expelled as sputum. Most common cause of excess m
Worsening cough = most common presenFng symptom of bronchia carcinoma smoking.
Bovine cough: explosive character of normal cough is lost when laryngeal paralysis is present, Mucoid sputum = clear and white; can contain black specks due to inhalaFon of
usually resulFng from carcinoma of bonchus infiltraFng the le> recurrent laryngeal nerve. Yellow/green sputum = presence of cellular material (bronchial epithelial cells, n
Cough may be accomp by stridor in whooping cough/ laryngeal or tracheal obstrucFon granulocytes); not necessarily due to infecFon; eosinophils in the sputum - same
Cough may persist in some individuals for many weeks following RTI, possibly due to persisFng Bronchiectasis: producFon of large quanFFes of yellow/green sputum
bronchial inflammaFon and inc airway responsiveness; may seTle with inhaled corFcosteroids Haemoptysis: blood-stained sputum; varies from small streaks of blood - massiv
acute infxn, esp in COPD exacerbaFon; Other common causes: pulm infarcFon,
In lobar pneumonia, sputum rusty in appearance when blood is present; Pink, fr
Breathlessness: Assess SOB in relaFonship to pt’s lifestyle. Moderate degree of SOB may be pulmonary oedema;
totally disabling if pt has to climb many flights of stairs to reach home. Bronchiectasis: blood o>en mixed with purulent sputum. Massive haemoptysis:
Dyspnoea: sense of awareness of inc resp effort - unpleasant. Pts may c/o Fghtness in chest usually due to bronchiectasis/ TB. Uncommon causes: idiopathic pulmonary hae
(differenFate from angina); may be due to cardiac or resp causes. LV failure (pressure rise in LA syndrome,microscopic polyangiiFs, trauma, blood disorders and benign tumour
and pulm capillaries àintersFFal and alveolar oedema, inc resp effort req to breathe).
Orthopnoea: form of breathlessness occurring when lying flat; lying flat redistributes blood, à Mucoid sputum: clear, thin, frothy
inc central and pulmonary blood vol. Lying flat causes abdominal contents to push against the Purulent: yellow/green; thick, viscid, offensive odour (pus)
diaphragm. Improved: prop up on pillows. Muco-purulent: both mucoid + purulent
Tachypnoea and Hyperpnoea: refer respecFvely to inc resp rate and inc level of venFlaFon Haemoptysis: bright red/ frothy blood
HypervenLlaLon: inappropriate over breathing; may occur at rest/ on exerFon; results in Current jelly: blood clots
lowering of the alveolar and arterial PCO2. Rusty: mucupurulent with red Fnge
Paroxysmal nocturnal dyspnoea: accumulaFon of fluid in lungs (pulmonary oedema) at night; Prune juice: dark brown, mucopurulent, offensive odour
as sensory awareness is depressed during sleep, severe intersFFal and alveolar oedema can Blood streaked
accumulate. Pt is woken from sleep fighFng for breath. May be relieved by sieng on the side of Pink/ frothy: pink + frothy; acute pulm oedema
bed/ geeng up. Wheezing, due to bronchial endothelial is common (cardiac asthma);
commonly see cough, producFve of frothy/blood Fnged sputum.
Air PolluLon
Atmospheric air polluFon due to burning of coal for energy and heat.
Chest Pain: Most common type of CP = encountered in resp disease = localised sharp pain; Primary pollutants: nitrogen oxides (NO and NO2), diesel parFculates, polyarom
o>en referred to as pleuriFc; worsened by deep breathing/cough; can be precisely localised by secondary pollutant ozone (O3) generated by photochemical reacFons in the at
paFent. Epidemiology: Black smoke and SO2 causes excess deaths from respiratory and
CostochrondriFs = localised anterior CP may be accompanied by tenderness of a costochondrial older populaFons; and symptoms of bronchiFs in children.
juncFon PolluFon from motor vehicles causes: increased deaths from respiratory and ca
IrritaFon of diaphragmaFc pleura: pain in shoulder Fp (parFculates <10um diameter; PM10); increased respiratory symptoms and red
Central CP radiaFng to the neck and arms = typical of cardiac origin. TracheiFs: retrosternal and younger adults (SO2, NO2, O3, PM10). Frequently, lag of 1-2 days between
soreness disease effects. Increased lung cancer: polyaromaFc hydrocarbons
Invasion of thoracic wall by carcinoma: constant, severe dull pain. Management: AsthmaFcs advised not to exercise outdoors during periods of po
increase their anF- inflammatory medicaFon (i.e. inhaled sodium cromoglicate/
corFcosteroids)
Wheezing: Common complaint; result of airflow limitaFon due to any cause; wheezing is not Short- and long-term measures are required to reduce air polluFon parFcularly
diagnosFc of asthma; may be absent in early stages of disease; may occur in paFents with motor e ngine efficiency, catalyFc converters, diesel parFculate traps and decre
bronchiectasis or COPD trucks.
Signs Of Respiratory Distress Smoking
Physical examinaLon: InspecFon; PalpaFon; Percussion; AuscultaFon. Prevalence: general decline in prevalence of smoking in men but not women; ci
InspecLon of hands: Peripheral cyanosis (blue Linger Fps); Flapping tremor (CO2 retenFon); common between 16-24 years.
Clubbing (increased curvature of nail) [Respiratory causes of Linger clubbing: bronchial Toxic Effects: Organic smoke contains polycyclic aromaFc hydrocarbons and nitr
carcinoma, bronchiectasis, empyema, lung abscess, lung Librosis]; NicoFne stains carcinogens and mutagens in animals). Causes release of enzymes from neutrop
InspecLon of Neck: Lymph Nodes (cervical) – done from back; Deviated trachea macrophages that are capable of destroying elasFn and leads to lung damage; p
InspecLon and appearance of chest: Tachypnoea (fast breathing); Scars; Skin metastasis; permeability increases even in symptomless cigareTe smokers, correlaFng with
Barrel chested (apex diameter similar to lateral side): chronic respiratory disorders e.g. COPD; in blood. Altered permeability possible allows earlier access to carcinogens.
Pectus excavarFum (sunken chest); Pectus carinatum (sFcking out sternum) The dangers: cigareTe smoke = addicFve; nicoFne - persistence, advantageous
InspecLon – Breathing Rate: Breathing paTern: shallow, Kussmaul, Cheyne-stokes, pursed lips Sputum producFon and airflow limitaFon inc with daily cigareTe consumpFon;
(COPD), orthopnoea (SOB on lying down; require propping up with pillows) part due to high levels of carboxyHb in bronchiFs paFents.
Chest wall movements: Expansion general/unilateral; Paradoxical: flail, intercostal recession, Smoking and asbestos exposures = synergisFc in producing bronchial carcinoma
indrawn ribs; Use of accessory muscles. asbestos exposures 5-8x that of non-smokers exposed to asbestos.
Scoliosis and kyphosis can influence the lungs (reduce expansion and bent forwards Environmental tobacco smoke = passive smoking; causes more frequent + more
respecFvely) Chest PalpaLon: place hand on paFent’s chest and check paFent’s chest is children; poss increases number of asthma cases. Associated with small but defi
expanding on both sides Smoking CessaLon: Smoking withdrawal clinics = 80% success rates in the first m
Barrel Chest: fail to see chest expansion = IndicaFve of COPD; chest already expanded 15-20% remain absFnent. NicoFne likely to be no beTer than verbal advice. Nico
Chest percussion: TympaniFc: hollow viscus placebo. Chest symptoms need to be severe to stop paFents from smoking.
Hyperresonant: PNTX; Resonant: normal lung; Impaired: consolidaFon/ collapse/ fibrosis; Dull: Pharmacological support: amfebutamone/ bupaprion (NAdr and DA re-uptake in
consolidaFon/ collapse/ fibrosis; Stony dull: pleural effusion
Chest AuscultaLon: Normal breath sounds are vesicular. General Dangers: Lung cancer, COPD, Carcinoma of the oesophagus, ischaemic
Decreased air entry: Generalised: emphysema; Localised: bronchial obstrucFon by tumour vascular disease, bladder cancer, increased abnormal spermatozoa, memory pro
(Tumour à bronchial obstrucFon); Thick chest wall; Pleural effusion/thickening Passive smoking dangers: Risk of asthma, pneumonia and bronchiFs in infants o
Added Sounds and SOB in smokers and non-smokers with COPD and asthma; increased risk of c
Ronchi (wheezes): Musical noise produced by air passing through narrowed airways e.g. Maternal smoking dangers: Decreased birthweight of infant; increased fetal and
