The document discusses respiratory anatomy and physiology, including:
1) How air moves from the bronchi to the terminal bronchioles and alveoli through the actions of respiratory muscles and elastic forces within the lungs.
2) How gas exchange occurs across the alveolar-capillary membrane through diffusion driven by partial pressure gradients.
3) How oxygen and carbon dioxide are carried around the body bound to hemoglobin in red blood cells.
Dear all,
This ppt includes the acute and chronic effect of exercise on different body system which includes musculoskeletal systems, cardiovascular systems, respiratory system, endocrive system, psychological effects etc. I hope this is helpful for you.
Thank you
Dear all,
This ppt includes the acute and chronic effect of exercise on different body system which includes musculoskeletal systems, cardiovascular systems, respiratory system, endocrive system, psychological effects etc. I hope this is helpful for you.
Thank you
Preoperative preparation for thoracic surgerySaneesh P J
The preoperative teaching process is best approached as a team effort, and multiple modalities often must be used so that the patient becomes a knowledgeable and willing member of the team. This perspective is described in case of preparation for thoracic surgery.
Introduction to respiration and mechanics of ventilation (the guyton and hall...Maryam Fida
Respiration is the process by which oxygen is taken in and carbon dioxide is given out.
Respiration is classified into two types:
1. External respiration
It involves exchange of respiratory gases, i.e. oxygen and carbon dioxide between lungs and blood.
2. Internal respiration
It involves exchange of gases between blood and tissues.
Respiration occurs in two phases:
Inspiration during which air enters the lungs from atmosphere.
2. Expiration during which air leaves the lungs.
During normal breathing, inspiration is an active
process and expiration is a passive process.
Respiratory tract is divided into two parts:
1. Upper respiratory tract that includes all the
structures from nose up to vocal cords; vocal cords are the folds of mucous membrane within larynx that vibrates to produce the voice
2. Lower respiratory tract, which includes Larynx, trachea, bronchi and lungs.
RESPIRATORY UNIT
Respiratory unit is defined as:
“The structural and functional unit of lung”. Exchange of gases occurs only in this part of the respiratory tract.
STRUCTURE OF RESPIRATORY UNIT
1. Respiratory bronchioles
2. Alveolar ducts
3. Alveolar sacs
4. Antrum
5. Alveoli
Between the trachea and alveoli airways divide 23 times
Out of 23 divisions first 16 are just to conduct air and these divisions of airways are up to terminal bronchioles.
The last 7 divisions are for the exchange of gases and these divisions which are for exchange of gases includes respiratory bronchioles, alveolar ducts and alveoli.
There are 300 million alveoli in the lungs and the alveolar surface form s an area of 70-100 square meters
Ok, heres the story. I was teaching this otherwise sharp EMT-Basic class that bombed two respiratory emergency tests in a ROW!
So this is the remedial lecture I inflicted on them. I don\'t know if they passed because of this fine work, or just because they were afraid of another lecture fo they failed.
Hope its useful to you.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
17. Terminal bronchioles have a
Broncioles branch many diameter of 0.5-1mm in
times and each division diameter.
produces tubules which are They are too thick for air
smaller exchange and considered to
be the last of the conducting
zone structures
18.
19. Type I cells account for gas
exchange.
Type II cells secrete surfactant
20. Functions of the lung
• Main function is gas exchange
– Allow passage of O2
– Allow removal of CO2
21. Functions of the lung
• Metabolic functions
– Surfactant synthesis
– Protein synthesis
– Metabolism of vasoactive substances
• ACE/Bradykinins
• Blood reservoir
– Volume = 450mls
• Allows phonation
22. Functions of the lung
• Heat exchange
• Immunological
– Alveolar macrophages
– IgA production
– Mucociliary escalator
23. Ventilation Mechanics
How air gets to the alveoli.
Gas Exchange
How gas crosses the
blood gas interface.
Gas Transport
How they are carried
around the body.
24. Ventilation Mechanics
How air gets to the alveoli.
Muscles
Diaphragm
Inspiration External Intercostal Muscles
Accessory muscles
Abdominal Muscles
Expiration
Internal Intercostal muscles assist
25. Ventilation Mechanics
How air gets to the alveoli.
Forces acting on the
lung
Elastic Tissue
Elastic tissue of
lungs is stretched
under normal
conditions.
Resulting tension
acts as a force
pulling inwards on
visceral pleura
As chest wall and diaphragm
pull on outwards on parietal
pleura causing a negative
pressure in interpleural
space. This keeps the lungs
inflated
26. Ventilation Mechanics
How air gets to the alveoli.
Airway Resistance Lung Compliance
If radius halved then resistance increases the slope of the pressure-volume curve at a
16 fold particular lung volume
=> i.e. volume change per unit of pressure
Chief site of airway resistance is the medium change (mL/cmH2O)
sized bronchi. normal value = 200mLs/cmH2O
Peripheral airways contribute little resistance Lower compliance = more effort of breathing
Considerable small airway disease can
be present before being detected in
pressure changes. Posture affects lung volume, therefore
compliance
Factors determining Disease states
Lung volume Asthma leads to hyper-inflation
Bronchi supported by surrounding Fibrosis, collapse and consolidation all
tissue decrease distensibility
Their calibre is increased as the lung Emphysema increases compliance
expands
So as lung volume is reduced
resistance is increased
Contraction of bronchial smooth muscle
27. Ventilation Mechanics
How air gets to the alveoli.
Functional Residual Capacity
FRC- volume of gas remaining in lungs at end of FRC increases with
normal expiration Height
Changing from supine to erect
Volume of lung at which elastic forces causing Emphysema- gas trapping
recoil = thoracic chest wall forces causing
expansion FRC decreases with
Obesity
FRC = 30mls/kg = 2200 mls in supine 70kg adult Muscle paralysis and GA
Changing from supine to erect
Restrictive lung disease
Pregnancy
Raise intra-abdominal pressure
28. Gas Exchange
How gas crosses the
blood gas interface.
Rate of diffusion is:
Directly proportional to cross
sectional area across which
diffusion occurs
Inversely proportional to the
thickness of the membrane
Directly proportional to the
partial pressure of the gas
across both sides
29. Gas Exchange
How gas crosses the
blood gas interface.
The amount of time that blood is in contact with
the alveolus also influences gas exchange.
The speed of blood flow past the alveolus is:
0.75 seconds under normal conditions
0.25 seconds with heavy exercise
30. Gas Exchange
How gas crosses the
blood gas interface.
Ventilation-
Pleural pressure are higher
at the bases of the lungs.
So they receive 4 times
more ventilation than
apices.
Circulation-
Low pressures in pulmonary
circulation are affected by
gravity
Bases of upright lungs
receive 20 times more blood
flow than apices.
32. Respiratory Examination
• Common Problems- Asthma.
– Baseline control
• Usual exercise tolerance
• Frequency of attacks
• Best Peak expiratory flow rate
• Usual precipitating factors
• Medication
• Usual response to therapy
• Previous hospital/ITU admissions
• Symptoms suggestive of poor baseline control
Jonathan Downham 2010
33. Respiratory Examination
• Common Problems – Asthma
– Drug History
• Do they have a nebuliser at home?
• Do they use a bronchodilator?
• Do they take theophylline or aminophylline?
(bronchodilators).
• Do they take steroids?
• Are they on medication which aggravates the
symptoms... Beta blockers, aspirin.
• Demonstrate inhaler technique.
Jonathan Downham 2010
34. Respiratory Examination
• Common Problems – Chronic Obstructive
Pulmonary Disease (COPD)
– Detailed history
• Time course
• Treatment given and effects
• Any hospital admissions in the last year
• Baseline function
• Chronically deteriorating exercise tolerance.
• Quantify normal amounts of sputum
Jonathan Downham 2010
35. Respiratory Examination
• Common Problems – Chronic Obstructive
Pulmonary Disease (COPD)
– Past Medical History
– Drug History
– Social History
– Review of systems.
Jonathan Downham 2010
36. Respiratory Examination
• Common Problems – Chest Infection
– History
• Cough
• Sputum Production
• Dyspnoea
• Wheeze
• Pleuritic chest pain
• Fever.
– Drug History.
Jonathan Downham 2010
Editor's Notes
Conducting zone allows movement of air in and out of lungsRespiratory zone allows diffusion of oxygen and carbon dioxide across capillary membranes
Larynx is a short 1.5 inch tube located in the throat below the base of the hyoid bone and tongue and oesophagusIn its walls it has supportive cartliges, interconnecting ligaments, intrinsic and extrinsic muscles and a mucosal lining.Its primary function is to provide a carefully guarded pathway between the pharynx and the trachea
9 laryngeal cartlidges2 sets of musclesIntrinsic muscles control the voiceExtrinsic muscles adjust the position of the larynx during swallowing
Thyroid cartlidge consists of two plates of hyaline cartlidge arranged in a wedge shape. These plates are fused along the anterior edge.At the top of the fused border the cartlidge extends anteriorly forming the laryngeal prominence or Adams appleHyoid bone serves as an attachment for the tongue muscles
Laryngeal muscles can adjust the size of the glottic openingThe glottis expands into a triangular shaped opening when breathingTo make sounds the laryngeal muscles reduce the size of the opening
Trachea is 4-5 inch vertical tube anterior to the oesophagusHas a wide lumen 1 inch to conduct air between the larynx and the primary bronchiEmbedded in the wall are tracheal rings made of hyaline cartlidge
4 Distinct layersMucosa with goblet cellsSubmucosa with blood vessels, neurons and glands which secrete combination of water and mucus to the surface of the tracheaCartilagionous layer containging C shaped ringsTrachealis muscles contracts on coughing which narrows lumen and increases velocity of airflow.Adventitia is loose connective tissue which binds the to the oesophagus and other nearby organs
The secondary bronchi are also known as lobar bronchi as each one directly conducts air to and from one of the lungs five lobes.
Point out apex and baseLeft lung has less volume because of space taken up by the heartPoint out pleura- will talk about this on next slide
Point out Hilum and what it is
Lung lobes are divided by connective tissue walls into compartments called bronchopulmonary segmentsEach segment functions independantly and is supplied by its own tertiary bronchus, artery, lymph vessels and autonomic nerves
When two or more alveoli share the same opening to an alveolar duct they are referred to as an alveolar sac.Approx 300 million alveoli in the lungs providing massive surface area for diffusion of gases.
MusclesInspirationDiaphragmInserted into lower ribsSupplied by phrenic nerves from C3,4,5In normal breathing moves about 1cmIn forced inspiration/expiration can move about 10cmExternal intercostal musclesConnect adjacent ribsSupplied by intercostal nerves coming off at C3,4,5Paralysis does not seriously affect breathing because diaphragm is so effectiveAccessory musclesScalene- elevate first two ribsSternomastoids- elevate sternum
Inhaler Technique Scoring Prepares Device (e.g. Shakes inhaler) 1 Exhales fully 1 activates and inhales 1 holds breath for several seconds 1
Common Problems – Chronic Obstructive Pulmonary Disease (COPD)Detailed historyIn an acute exacerbation patients usually present following a cold with deterioration of dyspnoea in association with a productive cough and discoloured sputum.Time courseTreatment given and effectsAny hospital admissions in the last yearBaseline functionHow far can you walk?Can you climb one flight of stairs easily?Chronic bronchitisHistory of cough, productive of sputum on most days, for 3 consecutive months, for at least 2 years.Emphysema is a pathological diagnosis of dilatation and destruction of the lungs distal to the terminal bronchioles
Past Medical HistoryPrevious admissions to hospital with acute exacerbations of COPDOther smoking related illnesses (ischeamic heart disease, peripheral vascular disease, strokes, hypertension)Other causes of lung disease (occupational exposure to dust, previous TB)AsthmaDrug HistoryBronchodilatorsHome oxygenWho initiated and on what evidenceHow many hours per day is it being usedLTOT should be used for greater than 15 hours per day and its aim is to prevent cor pulmonaleCaused by increase in blood pressure in the pulmonary artery which leads to enlargement and subsequent failure of the right side of the heart.Theophyliine.. Have levels been measuredSteroidsInhaler techniqueSocial HistoryConsider all aspects of daily livingNeed to stop smoking!!
CoughDuration, productive or drySputum ProductionQuantity, colour, recent changesDyspnoeaQuantitative account of exercise tolerance at baseline and during the illnessWheezePleuritic chest painCommon feature of pneumonia- be aware of pulmonary embolusFever.If symptoms are prolonged , recurrent or associated with weight loss consider the possibility of an underlying malignancy especially if they are a smoker.