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Symptomatology of Respiratory
Disorders
Department ofMedicine
ACMS
Female, 45 years, Nurse,
• Fever and weight loss X 2 months
• Productive cough X 2 months
• Blood in sputum X 2 days
Male, 18 year, Medical student
• Fever X 2 days
• Sore throat and running nose X 1 day
• Dry and painful cough X 1 day
55 year old soldier, Smoker
• Breathlessness and wheezing
• Productive Cough- more in the mornings
• Yellow sputum, approx 1 cupful X 1 week
• Similar problem every winter for over 15 years
that takes months to clear up.
• Mild symptoms persist throughout the year
Female, 50 years, Army wife
• Dry, distressing cough X 15 days
• Recently started on treatment for high BP
Tab Indapamide and Tab Enalapril
Why do patients consult ?
–Discomfort
–Interference with normal life
–Fear/ concern
1. Cough
• Explosive expiration against a closed glottis-
Purpose- clearance of airways
Protective Superficial Reflex
• Afferent- Trigeminal, Glossopharyngeal, Sup
Laryngeal (Vagus)
• Efferent- Recurrent Laryngeal (Vagus) and
Spinal nerves
Cough Triggers
• Exogenous- Fumes, smoke, dust, Foreign body
• Endogenous- Secretions, gastric contents
• Initiate inflammation- persistence of cough
• Constriction
• Infiltration
• Compression
Cough Causes
Inflammation Infections, Post nasal drip,
GERD
Constriction Asthma, scarring, tumors
Infiltration Granulomatous diseases,
Malignancy
Compression Lymph nodes, Mediastinal
tumors, Aortic aneurysm
Other ACE Inhibitors
Cough Associations
Origin Common Cause Clinical Features
Pharynx Post nasal drip H/O chronic rhinitis
Larynx Laryngitis
Tumor
Whooping cough
Croup
Voice change, odynophagia, painful, harsh
Longer duration
Paroxysms of cough
Associated stridor
Trachea Tracheitis Retrosternal pain
Bronchi Acute Bronchitis
COPD
Asthma
Carcinoma
Dry/ productive; Associated fever; Short duration
Productive; morning worsening ; long duration
Usually dry, worse at night
Persistent (with hemoptysis)
Parenchyma TB
Pneumonia
Bronchiectasis
abscess
Pulmonary edema
Interstitial fibrosis
Productive (with hemoptysis)
Initially dry, later productive
Productive (postural change)
Postural
Nocturnal (pink frothy sputum)
Dry, irritant & distressing
Pleura Parietal pleura Pleurisy/ during aspiration
Questions ?
• Duration- Acute/ Chronic (3 weeks)
• Associated infection
• Seasonal
• Wheezing
• Post nasal drip/ GERD
• Sputum
• Associated conditions (smoking, HIV,
occupation)
• Drug therapy
60 year old female in C4 ward
• Progressive neurological illness X 2 months
• Weakness all 4 limbs
• Difficulty in swallowing
• Weakness of trunkal muscles
• Ineffective cough
Baby boy, 2 years
• Breathlessness and cough 1 hour ago
• Loud and noisy breathing since then
• Blue discoloration of skin X 10 minutes
• Was playing with toys unattended when this
happened
• Ineffective Cough- Muscle disease/ paralysis
• Bovine Cough -single vocal cord paralysis
Noisy Breathing
• Stridor- Inspiratory sound (partial obstruction
of large airway) Laryngeal level
• Stertor- Oropharyngeal level
• Rattling – Tracheal level
• Wheezing – Bronchial level
Male, 35 years, Alcoholic
• Low grade fever and weight loss X 1 Month
• Cough X 1 month
• sputum production X 15 days
• Sputum is purulent, blood tinged, foul
smelling. More while lying on the left side
2. Sputum Production
• Quantity- nil, scanty, moderate (qty) copious
• Quality-
– Mucoid
– Muco-purulent
– Purulent
– Current Jelly
– Greenish
– Granules – yellow/ black
– Hydatid cysts
– Anchovy sauce (brown)
• Odour (smell)
45 year old diabetic
• Diarrheal illness 4 days ago
• Fever and chest pain X 2 days
• Cough X 1 day
• Current Jelly like blood in sputum
3. Hemoptysis
ALWAYS ALARMING
Differentiate from
• nasopharyngeal bleed
• Epistaxis
• Hematemesis
Quantity-
• Streaking
• Rusty, Mixed
• Massive (> 100 ml / > 600 ml/ 24 hrs)
45 year old male, Smoker
• Change of voice X 1 month
• Worsening cough X I month
• Blood in sputum X 2 days
Causes of Hemoptysis
Site Common Causes Rare Causes
Tracheo bronchial Carcinoma
Bronchitis
Bronchiectasis
Adenoma
Foreign body
Parenchyma TB & Chronic Pneumonia
Acute Pneumonia
Lung abscess
Parasites
Trauma
Actinomycetes
Mycetoma
Lung Vasculature Infarction
PAN
Good Pasteur’s syndrome
Idiopathic pulmonary
hemosiderosis
CVS Disease Ac LVF
MS
Aortic Aneurysm
Blood Disorders Leukemia
Hemophilia
Anticoagulants
Questions ?
• Where from
• How much
• Single episode/ multiple
• Other sites
• Other complaints
• Pre existing disease
• Age group
• Occupation
• Injury
• Drugs
4. Breathlessness
Mechanism is complex
• Sensory endings stimulation
• Work of breathing (muscles)
• Small airway obstruction
• Chemoreceptor stimulation (acidosis)
70 year old male, non smoker
• Previously an employee of Union Carbide
factory in Bhopal
• Progressively worsening breathlessness for 29
years
• Intermittent respiratory infections
30 year old HIV Positive,
• Dry Cough X 3 weeks
• Progressive Breathlessness X 2 weeks
• Moderate Fever and weight loss X 2 weeks
• Last CD4 200 cells
Chronic Exertional Breathlessness
• COPD
• Asthma
• Heart disease
• Interstitial or Alveolar disease
• Chest wall / Respiratory muscle disease
• Chronic Pulmonary Thrombo- embolism
• Psychogenic hyperventilation
Dry Cough
40 year old postman, cycling every
day, non smoker
• Sudden onset and worsening by the minute-
Breathlessness and Chest pain X 1 hour
• Cyanosed
• Percussion-
Acute Severe Breathlessness
• Pulmonary Edema
• Massive Pulmonary Embolism
• Acute Severe Asthma
• Acute Exacerbation of COPD
• Severe Pneumonia
• Tension Pneumothorax
• Foreign body/ mucous plug
• Epiglottitis (children)
• Metabolic Acidosis
• Psychogenic
Questions ?
• Symptom Scale
• Precipitating event
• Associated complaints
• Pre existing disease
• Age group
• Occupation
5. Chest Pain
Central Peripheral
Cardiac Lungs
Aortic Pleura
Esophageal Muscular
Massive Pulmonary Embolism Skeletal
Tracheitis Neurological
Mediastinitis
Respiratory causes
• Raw upper sternal- Tracheitis
• Pleuritic- associated with breathing
• Shoulder - lower lobes/ diaphragm
• Neurologic- invasion of nerves
40 year old smoker
• Hoarseness of voice X 3 weeks
• Dry irritative cough X 3 weeks
• Blood in sputum X 1 day
A R Rehman, Musician
• Weakness of voice after tour 10 concerts in 2
weeks
6. Voice Change (Dysphonia)
Structural Problems
Neurological Problems
• Hoarseness
• Weakness
• Aphonia
Causes
Inflammatory Acute and chronic laryngitis
Smoke inhalation
Neoplastic Carcinoma
Laryngeal Papillomatosis
Recurrent Laryngeal Nerve Post Thyroidectomy
Carcinoma of lung/ breast
Neurological Myasthenia gravis
Hypothyroidism, Rheumatoid Arthritis
Habitual Dysphonias Renke’s Dysphonia, Singer’s nodules
Vocal cord polyps,
GERD Reflux
Psychogenic Musculoskeletal tension,Dysphonia
Conversion Disorders
Questions
• Quality
• Time course
• Onset and other associations
• Other diseases
• Waxing and waning
• Level of discomfort
• Smoker
7. Hiccups
• Diaphragmatic irritation
Causes
• Respiratory- Basal pneumonia, Pleurisy
• CVS
• Upper GI
• Metabolic

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Symptomatology of Respiratory Disorders

  • 2. Female, 45 years, Nurse, • Fever and weight loss X 2 months • Productive cough X 2 months • Blood in sputum X 2 days
  • 3. Male, 18 year, Medical student • Fever X 2 days • Sore throat and running nose X 1 day • Dry and painful cough X 1 day
  • 4. 55 year old soldier, Smoker • Breathlessness and wheezing • Productive Cough- more in the mornings • Yellow sputum, approx 1 cupful X 1 week • Similar problem every winter for over 15 years that takes months to clear up. • Mild symptoms persist throughout the year
  • 5. Female, 50 years, Army wife • Dry, distressing cough X 15 days • Recently started on treatment for high BP Tab Indapamide and Tab Enalapril
  • 6. Why do patients consult ? –Discomfort –Interference with normal life –Fear/ concern
  • 7. 1. Cough • Explosive expiration against a closed glottis- Purpose- clearance of airways Protective Superficial Reflex • Afferent- Trigeminal, Glossopharyngeal, Sup Laryngeal (Vagus) • Efferent- Recurrent Laryngeal (Vagus) and Spinal nerves
  • 8. Cough Triggers • Exogenous- Fumes, smoke, dust, Foreign body • Endogenous- Secretions, gastric contents • Initiate inflammation- persistence of cough • Constriction • Infiltration • Compression
  • 9. Cough Causes Inflammation Infections, Post nasal drip, GERD Constriction Asthma, scarring, tumors Infiltration Granulomatous diseases, Malignancy Compression Lymph nodes, Mediastinal tumors, Aortic aneurysm Other ACE Inhibitors
  • 10. Cough Associations Origin Common Cause Clinical Features Pharynx Post nasal drip H/O chronic rhinitis Larynx Laryngitis Tumor Whooping cough Croup Voice change, odynophagia, painful, harsh Longer duration Paroxysms of cough Associated stridor Trachea Tracheitis Retrosternal pain Bronchi Acute Bronchitis COPD Asthma Carcinoma Dry/ productive; Associated fever; Short duration Productive; morning worsening ; long duration Usually dry, worse at night Persistent (with hemoptysis) Parenchyma TB Pneumonia Bronchiectasis abscess Pulmonary edema Interstitial fibrosis Productive (with hemoptysis) Initially dry, later productive Productive (postural change) Postural Nocturnal (pink frothy sputum) Dry, irritant & distressing Pleura Parietal pleura Pleurisy/ during aspiration
  • 11. Questions ? • Duration- Acute/ Chronic (3 weeks) • Associated infection • Seasonal • Wheezing • Post nasal drip/ GERD • Sputum • Associated conditions (smoking, HIV, occupation) • Drug therapy
  • 12. 60 year old female in C4 ward • Progressive neurological illness X 2 months • Weakness all 4 limbs • Difficulty in swallowing • Weakness of trunkal muscles • Ineffective cough
  • 13. Baby boy, 2 years • Breathlessness and cough 1 hour ago • Loud and noisy breathing since then • Blue discoloration of skin X 10 minutes • Was playing with toys unattended when this happened
  • 14. • Ineffective Cough- Muscle disease/ paralysis • Bovine Cough -single vocal cord paralysis Noisy Breathing • Stridor- Inspiratory sound (partial obstruction of large airway) Laryngeal level • Stertor- Oropharyngeal level • Rattling – Tracheal level • Wheezing – Bronchial level
  • 15. Male, 35 years, Alcoholic • Low grade fever and weight loss X 1 Month • Cough X 1 month • sputum production X 15 days • Sputum is purulent, blood tinged, foul smelling. More while lying on the left side
  • 16. 2. Sputum Production • Quantity- nil, scanty, moderate (qty) copious • Quality- – Mucoid – Muco-purulent – Purulent – Current Jelly – Greenish – Granules – yellow/ black – Hydatid cysts – Anchovy sauce (brown) • Odour (smell)
  • 17. 45 year old diabetic • Diarrheal illness 4 days ago • Fever and chest pain X 2 days • Cough X 1 day • Current Jelly like blood in sputum
  • 18. 3. Hemoptysis ALWAYS ALARMING Differentiate from • nasopharyngeal bleed • Epistaxis • Hematemesis Quantity- • Streaking • Rusty, Mixed • Massive (> 100 ml / > 600 ml/ 24 hrs)
  • 19. 45 year old male, Smoker • Change of voice X 1 month • Worsening cough X I month • Blood in sputum X 2 days
  • 20. Causes of Hemoptysis Site Common Causes Rare Causes Tracheo bronchial Carcinoma Bronchitis Bronchiectasis Adenoma Foreign body Parenchyma TB & Chronic Pneumonia Acute Pneumonia Lung abscess Parasites Trauma Actinomycetes Mycetoma Lung Vasculature Infarction PAN Good Pasteur’s syndrome Idiopathic pulmonary hemosiderosis CVS Disease Ac LVF MS Aortic Aneurysm Blood Disorders Leukemia Hemophilia Anticoagulants
  • 21. Questions ? • Where from • How much • Single episode/ multiple • Other sites • Other complaints • Pre existing disease • Age group • Occupation • Injury • Drugs
  • 22. 4. Breathlessness Mechanism is complex • Sensory endings stimulation • Work of breathing (muscles) • Small airway obstruction • Chemoreceptor stimulation (acidosis)
  • 23. 70 year old male, non smoker • Previously an employee of Union Carbide factory in Bhopal • Progressively worsening breathlessness for 29 years • Intermittent respiratory infections
  • 24. 30 year old HIV Positive, • Dry Cough X 3 weeks • Progressive Breathlessness X 2 weeks • Moderate Fever and weight loss X 2 weeks • Last CD4 200 cells
  • 25. Chronic Exertional Breathlessness • COPD • Asthma • Heart disease • Interstitial or Alveolar disease • Chest wall / Respiratory muscle disease • Chronic Pulmonary Thrombo- embolism • Psychogenic hyperventilation Dry Cough
  • 26. 40 year old postman, cycling every day, non smoker • Sudden onset and worsening by the minute- Breathlessness and Chest pain X 1 hour • Cyanosed • Percussion-
  • 27. Acute Severe Breathlessness • Pulmonary Edema • Massive Pulmonary Embolism • Acute Severe Asthma • Acute Exacerbation of COPD • Severe Pneumonia • Tension Pneumothorax • Foreign body/ mucous plug • Epiglottitis (children) • Metabolic Acidosis • Psychogenic
  • 28. Questions ? • Symptom Scale • Precipitating event • Associated complaints • Pre existing disease • Age group • Occupation
  • 29. 5. Chest Pain Central Peripheral Cardiac Lungs Aortic Pleura Esophageal Muscular Massive Pulmonary Embolism Skeletal Tracheitis Neurological Mediastinitis
  • 30. Respiratory causes • Raw upper sternal- Tracheitis • Pleuritic- associated with breathing • Shoulder - lower lobes/ diaphragm • Neurologic- invasion of nerves
  • 31. 40 year old smoker • Hoarseness of voice X 3 weeks • Dry irritative cough X 3 weeks • Blood in sputum X 1 day
  • 32. A R Rehman, Musician • Weakness of voice after tour 10 concerts in 2 weeks
  • 33. 6. Voice Change (Dysphonia) Structural Problems Neurological Problems • Hoarseness • Weakness • Aphonia
  • 34. Causes Inflammatory Acute and chronic laryngitis Smoke inhalation Neoplastic Carcinoma Laryngeal Papillomatosis Recurrent Laryngeal Nerve Post Thyroidectomy Carcinoma of lung/ breast Neurological Myasthenia gravis Hypothyroidism, Rheumatoid Arthritis Habitual Dysphonias Renke’s Dysphonia, Singer’s nodules Vocal cord polyps, GERD Reflux Psychogenic Musculoskeletal tension,Dysphonia Conversion Disorders
  • 35. Questions • Quality • Time course • Onset and other associations • Other diseases • Waxing and waning • Level of discomfort • Smoker
  • 36. 7. Hiccups • Diaphragmatic irritation Causes • Respiratory- Basal pneumonia, Pleurisy • CVS • Upper GI • Metabolic