Signs and Symptoms of Respiratory Diseases

Cough

A sudden audible expulsion of air from the lungs. Coughing is proceeded by inspiration, the glottis is partially closed and the accessory muscles of expiration contract to expel the air forcibly from the respiratory passages. Coughing is a essential protective response that serves to clear the lungs.Bronchi or trachea of irritants and secretions or to prevent aspiration of foreign material into the lungs. Material coughed up from the lungs and expectorated through the mouth. It contains mucus, cellular derbis or microorganisms and it may content blood or pus.The amount, colour and constituents of the sputum  are important in the diagnose of many illness.

Dry Cough – Pleuritis, ILD

Productive Cough -Chronic bronchitis ,Suppurative lung disease, Tuberculosis.

Brassy Cough – Trachea 1 compression

Bovine Cough -Recurrent laryngeal palsy, laryngitis

Nocturenal Cough -Chronic bronchitis, Bronchial asthma,Aspiration, Tropical eosinophilia, Left sided heart failure.

Cough syncope

It is due to raised intrathoracic pressure with reduced venous return to heart, reduced cardiac output and cerebral ischaemia.

 

Aetiology

1. In resp. tract

      Pharyngeal (and Laryngeal): Infection

       Pulmonary : Pneumonia , TB, etc.

       Pleural effusion: Pneumothorax

       Pressure : Mediastinal growth, aneurysm

2. Outside respiratory tract

              Auditory : Wax or inflammation

              Abscess: Liver, subphrenic

              Anxiety

Types

       Asthmatic: Mostly nocturnal

       Bovine : Vocal cord paralysis

       Croupy: Laryngeal infection

       Dry : TB

       Expectorant: Bronchitis, brotichiectasis

       Foetid: Anaerobic infection

       Gander (metallic): Mediastinal compression

       Hacking: Postnasal drip

       Intermittent (Staccato): Whooping cough

Cardiac

Cyanotic congenital heart disease

Infective endocarditis

Extra-thoracic
        Endocrine: Thyroid acropachy
Familial or idiopathic
Gastro-intestinal disease: Crohn’s disease
Hepatic disease: Cirrhosis 

Sputum

Yellow thick/Green thick – Bacterial infections

Rusty – Pneumococcal pneumonia

Red currant jelly – sticky – Klebsiella pneumonia

Pink frothy – Pulmonary edema

Blood tinged – Bronchitis, bronehiectasis, bronchial adenoma, tuberculosis, malignancy

Ancovy sauce -Ruptured amoebic liver abscess

Copious colourless -Alveolar cell carcinoma

Copious-purulent – Lung abscess, bronchiectasis necrotising pneumonia.

Foul smelling sputum

       Abscess, Anaerobic lung abscess

       Bronchiectasis, Bronchiectasis,

       Carcinoma (breaking down)

       Diaphragmatic abscess (bursting into lung)

       Empyema (bursting into lung)

       Foetid bronchitis

       Gangrene lung

Difficulty in Breathing

Dyspnoea

It is defined as undue awareness of respiratory effort or of the need to increase the effort as in thickened pleura, pleural effusion, pneumothorax, hypoxia, anaemia, acidosis etc. J receptors in alveoli stretch receptors of thoracic cage, chemoreceptors in carotid arteries are all involved.

Causes

Within minutes, Pneumothorax, Pulmonary edema, Pulmonary embolism, Laryngeal edema, Foreign body,

Within hours-days, Asthma, Pneumonia, Allergic alveolitis. Massive consolidation, ARDS collapse

Within weeks-months, Pleural effusion, Fibrosing alveolitis,Emphysema,Pneumoconiosis, Pleural fibrosis, Anaemia.

Orthopnoea

Orthopnoea defines dyspnoea on recumbency.

     Causes of orthopnoea

LV failure, pericardial effusion.

Bronchial asthma, bilateral diaphragmatic palsy.

Large ascites, GERD, obstructive sleep apnoea.

Platypnoea

It is dyspnoea worse on upright position, commonly due to a-v malformation at lung bases.

Breathing Patterns

     I. Regular abnormal

Cheyne Stokes – hyperpnoea followed by apnoeic as in cardiac failure, narcotic over dose, raised ICP

Kussmaul’s – Increase in rate and depth as in metabolic acidosis and pontine lesions.

     II. Irregular abnormal

Biot’s – Shallow or deep breaths with apneic spells as in meningitis.

Ataxic – Deep and shallow breaths occurring randomly as in brain stem lesion.

Apneustic – Pause after inspiration and expiration as in pontine lesions.

Cogwheel – Interrupted breathing in anxiety

Pursed lip – Emphysema.

Chest Expansion

        Normal 5-8 cm

General restriction – Emphysema, ankylosing spondylitis, interstitial lung disease

Asymmetrical restriction – Fibrosis, collapse, pneumothorax, pleural effusion, pneumonia

Percussion Note

Tympanitis – Hollow viscus

Skodiac – Above level of pleural effusion

Hyper resonant – Pneumothorax

Resonant – Normal lung

Impaired – Pulmonary fibrosis, thick walled cavity

Dull – Consolidation, collapse, thickened pleura

Stony dull – Pleural effusion

Impaired or Dull note

         Abscess

         Bronchogenic Ca

         Collapse, Consolidation

         Diaphragm raised (uncommon)

         Effusion (and thickened pleura)

         Fibrosisof Jung

Obliteration of Traube’s space occurs in left sided pleural effusion, massive splenomegaly, massive percicardial effusion,

Upward shift ofTraube’s space, occurs in left lower lobe fibrosis, left diaphragmatic palsy.

Hyper-resonant note

        Airinpleural cavity

        Bulla

        Cavity

        Cyst

        Distension of stomach

        Diaphragmatic eventration

        Diaphragmatic hernia

        Emphysema

 Breath sounds

          Diminished  – Thickened pleura, emphysema, collapsed lung with occluded bronchus, tumor.

         Absent – Massive pleural effusion, pneumothorax, severe asthma.

Bronchial Breathing Sounds

Tubular breathing is high pitched heard over consolidation, collapsed lung with patent bronchus and above level of pleural effusion (a partially collapsed lung with patent bronchus).

Amphoric breathing is of low pitched metallic quality heard over large superficial cavity, tension pneumothorax, bronchopleural fistula

Cavernous breathing is low pitched heard over thick walled cavity with a communicating bronchus.   

        Type                                       Causes

Cavernous                             Consoldiation

Amphoric                              Cavity

Tubular                                  Collapse

 Vocal Resonance

Increased:      Consolidation

Cavity (superficial)

      Decreased :   Air in pleural cavity

                            Bronchial obstruction

                            Collapse

                            Diaphragmatic hernia

                            Effusion, emphysema

                            Fibrosis

Crackles (Rales)

Fine crackles are high pitched, short duration and arise from alveoli. Coarse crackles are low pitched and arise from bronchus and bronchioles. Early inspiratory crackles occur in chronic bronchitis, mid inspiratory in bronchiectasis and late inspiratory in pneumonitis, ILD, pulmonary edema, pulmonary fibrosis. Expiratory crackles occur in chronic bronchitis and pulmonary edema.

         Abscess, ARDS

         Bronchi ectas is

         Consolidation

         Decompensation

         Edema

          Fibrosis

Wheezes (Rhonchi)

            Polyphonic                                                   Monophonic

More expiratory                                           Insp. or expiratory

Large number                                                Single or few

Not widely heard                                          Wide conduction

Loud. Can be heard with                             Cannot be heard with  unaided car (except stridor)

Causes

      Congestion or thickening of mucous lining

      Constriction of smooth ms. of bronchi

      Chronic bronchitis, emphysema

If single wheeze on inspiration – Stenosis or FB or lymphnode or

      Ca obstructing principalbronchus.

 Pleural Rub

Audible during both phases of respiration

Better heard on increased pressure of stethoscope.

Cough does not change rub

Defined area (Localised)

Eliminated by holding breath

Frequently associated with localised pain and tenderness

Grating in character

 Differentiation between pleural rub and crackle

                                                   Rub                                         Crackle

Continuous                              Discontinuous

Superficial loud                        Deep

Usually localised                     May be diffuse

Unaffected by cough                Intensified or abolished by cough

Pressure with stethoscope       No effect                                 Increased intensity

Pain and tenderness                No pain or tenderness

 

Succussion Splash

Obstruction of the Pyloric outlet can be checked by succussion splash.Simultaneously listening in the epigastrium and shaking the upper abdomen from side to side.

      Hydropneumothorax

      Herniation of stomach or colon into thorax

      Huge cavity with fluid and air