SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES PRESENTERS MALICK

SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES PRESENTERS: MALICK FAYE AND BABOUCARR DAFFEH

SYMPTOMS Runny, blocked nose and sneezing Cough Sputum Breathlessness Wheezing Chest pain

Runny, blocked nose and sneezing Nasal symptoms are extremely common. It can be difficult to distinguish between the common cold or allergic rhinitis as a cause of 'runny nose' (rhinorrhoea), nasal blockage and attacks of sneezing. Colds are frequent, but if persist for weeks the patient is probably suffering from perennial rhinitis rather than from persistent infection due to a virus. Nasal secretions are usually thin and runny in rhinitis but thicker and yellowish green in the common cold. However, a blood-stained nasal discharge associated with nasal obstruction and pain (nasal tumour). Total nasal blockage with loss of smell (nasal polyps).

Cough is the most common symptom of lower respiratory tract disease. A productive cough is the cardinal feature of chronic bronchitis, while dry coughing, particularly at night, can be a symptom of asthma. Cough also occurs in asthmatics after mild exertion or following a forced expiration. A worsening cough is the most common presenting symptom of a bronchial carcinoma. The explosive character of a normal cough is lost when a vocal chord is paralysed - a bovine cough - usually as a result of a carcinoma of the bronchus infiltrating the left recurrent laryngeal nerve. Cough can be accompanied by stridor in whooping cough and in the presence of laryngeal or tracheal obstruction.

Sputum Approximately 100 m. L of mucus is produced daily in a healthy, non-smoking individual. Excess mucus is expectorated as sputum. The most common cause of excess mucus production is cigarette smoking. Mucoid sputum is clear and white but can contain black specks resulting from the inhalation of carbon. Yellow or green sputum is due to the presence of cellular material, including bronchial epithelial cells, or neutrophil or eosinophil granulocytes. Yellow sputum is not necessarily due to infection, as eosinophils in the sputum, as seen in asthma, can give the same appearance. The production of large quantities of yellow or green sputum is characteristic of bronchiectasis.

Haemoptysis (blood-stained sputum) varies from small streaks of blood to massive bleeding. The most common cause of haemoptysis is acute infection, particularly in exacerbations of chronic obstructive pulmonary disease (COPD) but it should not be attributed to this without investigation. Other common causes are pulmonary infarction, bronchial carcinoma and tuberculosis. In lobar pneumonia, the sputum is rusty in appearance when blood is present. Pink, frothy sputum is seen in pulmonary oedema.

Cont. . . In bronchiectasis, the blood is often mixed with purulent sputum. Massive haemoptyses (> 200 m. L of blood in 24 hours) are usually due to bronchiectasis or tuberculosis. Uncommon causes of haemoptyses are idiopathic pulmonary haemosiderosis, Goodpasture's syndrome, microscopic polyangiitis, trauma, blood disorders and benign tumours. Haemoptysis should always be investigated. Often, the diagnosis can be made from a chest X-ray, but a normal chest X-ray does not exclude disease.

Firm plugs of sputum may be coughed up by patients suffering from an exacerbation of allergic bronchopulmonary aspergillosis. Sometimes such sputum may appear as firm threads representing casts from inflamed bronchi.

Breathlessness should be assessed in relation to the patient's lifestyle. For example, a moderate degree of breathlessness may be totally disabling if the patient has to climb many flights of stairs to reach home. Dyspnoea is a sense of awareness of increased respiratory effort that is unpleasant and that is recognized by the patient as being inappropriate. Patients may complain of tightness in the chest.

Orthopnoea is breathlessness on lying down and is partly due to the weight of the abdominal contents pushing the diaphragm up into the thorax. Such patients may also become breathless on bending over. Tachypnoea and hyperpnoea refer, respectively, to an increased rate of breathing and an increased level of ventilation, which may be appropriate to the situation (e. g. during exercise). Hyperventilation is inappropriate overbreathing. This may occur at rest or on exertion and results in a lowering of the alveolar and arterial Pco 2

Wheezing is a common complaint and is the result of airflow limitation due to any cause. The symptom of wheezing is not diagnostic of asthma; it may be absent in the early stages of this disease, and may also occur in patients with bronchiolitis or chronic obstructive pulmonary disease.

Chest pain The most common type of chest pain encountered in respiratory disease is a localized sharp pain, often referred to as pleuritic. It is made worse by deep breathing or coughing and can be precisely localized by the patient. Localized anterior chest pain may be accompanied by tenderness of a costochondral junction as a symptom of costochondritis.

Cont. . . Pain in the shoulder tip suggests irritation of the diaphragmatic pleura, whereas central chest pain radiating to the neck and arms is typically of cardiac origin. Retrosternal soreness may occur in patients with tracheitis, and a constant, severe, dull pain may be the result of invasion of the thoracic wall by carcinoma.