Respiratory Symptoms

 

• Shortness of breath (SOB)

  Definitions

  • Dyspnoea: subjective experience of difficulty breathing.
  • Tachypnoea: increased respiratory rate.
  • Hyperpnea: increased depth of breathing.
  • Hyperventilation: increased alveolar ventilation.
  • Cheyne-Stokes breathing: apnoea alternating with deep breaths/tachypnoea. Often a pre-terminal event, and suggests brainstem hypoxia.
  • See-saw breathing: abdomen moves outward as chest moves inwards. Sign of complete airway obstruction.

  Respiratory causes

  Practically every respiratory disease can feature SOB. Here we list the commoner causes:

  • Chronic causes: asthma, COPD, interstitial lung disease.
  • Acute causes: PE, pneumothorax, pneumonia, acute asthma, inhaled foreign body.
  • Subacute causes: lung cancer, pleural effusion, hypersensitivity pneumonitis.

  Non respiratory causes

  • Cardiovascular: LVF (orthopnea, PND), IHD, arrhythmia, valve disease, pericardial disease.
  • GI: ascites, hepatomegaly.
  • Others: anaemia, DKA, anxiety, obesity, thoracic kyphosis.

• Cough

  Respiratory causes

  • Can be a feature of almost any respiratory disease.
  • Commonly, chronic cough is due to asthma or COPD.
  • Acute coughs are often infectious. Some have a distinctive sound, such as the barking cough of croup.

  Non-respiratory causes

  • Chronic rhinitis and post-nasal drip. Should respond to an intranasal steroid.
  • GORD. Should respond to PPIs.
  • Recurrent laryngeal palsy: bovine cough.
  • ACEi: dry cough.

  Productive cough

  • Clear, grey, white: asthma, COPD.
  • Green-yellow: infection, bronchiectasis
  • Pink frothy: pulmonary oedema.

• Haemoptysis

  Definitions

  • Haemoptysis: coughing blood which comes from the airways (below the larynx).
  • Recurrent haemoptysis: occurring on 2 separate days.
  • Not to be confused with haematemesis, which is vomiting blood, typically a much greater volume than in haemoptysis.

  Causes

  • Infective: acute or chronic bronchitis, TB, pneumonia.
  • Lung cancer.
  • Bronchiectasis
  • Vascular: PE, pulmonary hypertension, pulmonary oedema.
  • Inflammatory: pulmonary fibrosis, sarcoidosis.