Page 94 - Medicine and Surgery

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Respiratory system 3

Clinical, 90 Acute respiratory distress syndrome Pleural effusion, pneumothorax,
Respiratory procedures, 93 (ARDS), 119 pleurisy, 125
Respiratory infections, 97 Suppurative lung disorders, 120 Respiratory failure, heart disease
Obstructive lung disorders, 108 Granulomatous/vasculitic lung and embolism, 127
Restrictive lung disorders, 117 disorders, 123 Occupational lung disease, 131
Respiratory oncology, 134

Clinical Dyspnoea
Dyspnoea is an unpleasant sensation of difficulty in
Symptoms breathing. Patients may complain of breathlessness, dif-
ficulty in ‘catching their breath’, a feeling of suffocation,
Cough and sputum or tightness in the chest. Dyspnoea should be graded by
the exertional capability of the patient and the impact
Acough is one of the most common presentations of on their lifestyle. It is useful to document when breath-
respiratory pathology. The timing, onset, precipitating lessness occurs, e.g. after 200 yards on the flat, up 1 flight
factorsandprogressionofacoughshouldbenotedalong of stairs.
with the amount and appearance of sputum produced. In general dyspnoea arises from either the respira-
The most common patterns are shown in Table 3.1. tory or cardiovascular system and it is often difficult to
Haemoptysis (coughing up of blood from the lungs) distinguish between them. Although the presence of or-
may be caused by a number of conditions. It is usu- thopnoea and paroxysmal nocturnal dyspnoea suggests
ally streaky, rusty coloured and mixed with sputum. It a cardiovascular cause, patients with lung disease may
should be distinguished from haematemesis (vomiting experience orthopnoea due to abdominal contents re-
of blood) which may appear bright red or like coffee stricting the movement of the diaphragm.
grounds. For diagnosis, respiratory dyspnoea is best considered
1 The most common cause is acute infection, particu- according to the speed of onset and further differenti-
larly with underlying chronic obstructive airways dis- ated by a detailed history and clinical examination (see
ease. Table 3.2).
2 Other important causes are bronchial carcinoma and
tuberculosis – these should be looked for, unless in a
young, non-smoking patient with an acute infection. Wheeze and stridor
3 Pulmonary oedema in cardiac failure causes pink,
frothy sputum and pulmonary infarction such as pul- Wheeze and stridor are respiratory sounds caused by air-
monary embolism may cause haemoptysis. flow limitation – when predominantly expiratory these
4 OtherlesscommoncausesincludeGoodpasture’ssyn- musical sounds are wheezes, inspiratory sounds that do
drome, vasculitis such as microscopic polyarteritis, not clear on coughing are only caused by upper airway
cystic fibrosis and clotting abnormalities. obstruction and this is called stridor.
Massive haemoptysis may be caused by bronchiectasis, Awheeze is described according to where it is best
bronchial carcinoma or tuberculosis. heard and whether it is monophonic (limitation of a

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