Respiratory Symptoms

Common symptoms

 Cough
 Expectoration
 Hemoptysis
 Chest pain
 Cyanosis
 Dyspnea
Cough (a protective reflex): causes
 Respiratory diseases___ the most common c
auses
 Airway agents
 Bronchitis,
bronchiectasis, asthma, endobronchial
tuberculosis, tumor, pharyngitis
 Lung agents
 Infection, edema, fibrosis, tumor
 Pleural agents
 Pleurisy, pneumothorax, mesothelioma of pleura
Cough (a protective reflex): causes

 Cardiovascular diseases
 Cardiogenesis edema, pulmonary em
bolism
 Central nervous system agents
 Initiative cough, encephalitis, mening
itis
Cough : manifestations
 Characteristics
 Dry cough (non-sputum)
 Productive cough (sputum: infectious, edema)
 Attack
 Time (morning, midnight, early morning)
 Season (spring, summer, fall and/or winter)
 Motivation (fume inhalation, exertion)
 Tone
 Hoarseness
 High pitch
 Weak
 Brassy
Cough: accompany signs
 Fever (infection)
 Chest pain (infection, tumor, pleurisy, pneum
othorax, pulmo embolism)
 Dyspnea
 Hemoptysis (bronchietasis, tuberculosis, tum
or)
 Bulk pus sputum (bronchietasis, lung absces
s)
 Wheezing (asthma, foreign body)
 Clubbing fingers (bronchietasis, lung cancer,
chronic lung abscess)
Sputum: amount
 Bulk frothy sputum
 Pulmo edema

 Bulk serofluid sputum

 Alveolar cell carcinoma
 Bulk pus sputum
 Bronchiectasis
 Lung abscess

Layering
upper: frothy,
middle: mucoid or mucopus,
lower: necrosis substance
Sputum: consistency
 Mucoid sputum
 Bronchitis (without bacterial infection)
 Asthma
 Early stage of pneumonia
 Serofluid sputum
 Pulmo edema
 Pus sputum
 Any bacterial infection
 Bloody sputum
Sputum: color
 White
 mucoid or serofluid sputum
 Yellow
 general bacterial infection
 Green
 aeruginosus Bacillus infection
 Grey oror
Grey black
black
 dust inhalation
 Rusty
 Lobar pneumonia
 Pink
 cardiac edema
 Red
 hemoptysis
Sputum: foul odor

 anaerobic bacterium infection

Hemoptysis
 Bleeding from lower tract
 The amount varies from blood-strained sput
um to several hundreds ml pure blood
 Mild: 100ml/d
 Moderate: 100-500ml/d
 Severe: >500 ml/d, or 100-500 ml/h
 Differential diagnosis
 Bleeding from upper respiratory tract
 Hematemesis
Distinguished hemoptysis from hemat
emesis
Hemoptysis Hematemesis

Causes Pulmo or cardiac digestive system

Previous symptoms Cough, chest Nausea, vomiting

tightness
Spit up Cough up Vomited

Color Bright red Dark red

Mixture Sputum, frothy Gastric contents

pH alkality acidity
Tarry stools - or + +

Post-bleeding Sputum with blood No sputum

Hemoptysis: causes
 Bronchial disorders
 Bronchiectasis
 Bronchogenic carcinoma
 endobronchial TB
 Chronic bronchitis

 Pulmo Disorders
 Pulmo TB

 Peumonia
 Lung abscess
 Pulmo embolism
Hemoptysis: causes

 Cardiovascular disorders
 Acute left heart failure
 Mitral stenosis
 Others
 Hematologic disease, leptospirosis （钩端螺旋
体病）， epidemic hemorrhagic fever ， endom
etriosis （子宫内膜异位症）
Hemoptysis: accompany signs
 Fever
 Infection or carcinoma
 Chest pain
 Infection ， Pulmo Embolism ， Carcinoma
 Pus sputum
 Bronchiectasis ， Lung abscess
 Clubbing fingers
 Bronchiectasis ， Lung abscess ， Carcinoma
 Hemorrhagic spots
 Hematologic disease, leptospirosis, epidemic h
emorrhagic fever
Chest pain: causes
 Chest wall
 herpes zoster, rib fracture
 Cardiovascular
 angina pectoris, myocardial infarction, pericarditis, dissecti
ng aneurysm （夹层动脉瘤）
 Respiratory
 Pleural disorders, pneumothorax, carcinoma
 Mediastinal
 Mediastinitis, mediastinal emphysema, mediastinal tumor
 Others
 esophageal carcinoma, liver abscess, subdiaphragmatic ab
scess, hiatal hernia （食道裂孔疝）
Chest pain: characteristics
 location
 Referred pain
 feature
 Burning pain, pressing pain, bursting pain, pri
cking pain
 Duration
 Influential factors
 Exertional, respiration, food intake, administra
tion
Chest pain: accompany signs
 Cough, sputum and/or fever
 Respiratory disease
 Dyspnea
 Severe pneumonia, pneumothorax, pleurisy, pulmo embolis
m
 Hemoptysis
 Carcinoma, pulmo embolism
 Shock
myocardial infarction, dissecting aneurysm (rupture
), large area pulmo embolism
 Dysphagia ( 吞咽困难 )
 Esophageal disease
Cyanosis

 An excess of desaturated hemoglobin cause

s a blue coloration of the skin or mucosae.

 methemoglobinemia ( 高铁血红蛋白血症）

 Poisoning by nitrite
Cyanosis: classification

 Central (warm)
 Deficient oxygenation
 Right-to-left shunt
 Peripheral (cold)
 Reduced cardiac output
 Local vasoconstriction
 Mixed
 Heart failure
Cyanosis: accompany signs

 Dyspnea
 Severe cardiac or respiratory disorder
 Clubbing fingers
 Congenital heart disease
 Chronic respiratory disease
 Unconsciousness
 Poisoning, shock, Severe cardiac or respiratory
disorder
Dyspnea: causes
 Respiratory system
 Obstruction: asthma, COPD, tumor
 Pulmo Diseases: pneumonia, interstitial lung diseas
e,
 Chest wall or pleura: pleurisy, pneumothorax, traum
a
 neuro-muscles: poliomyelitis ( 脊髓灰质炎 ), myasth
enia gravis ( 重症肌无力 )
 Diaphragma movement disorder: obviously elevated
pressure in abdominal cavity
Dyspnea: causes
 Cardiovascular system
 Heart failure
 Pulmo embolism

 Poisoning
 ketoacidosis

 Central nervous system

 cerebral tumor , trauma, abscess, hemorrhage, ence
phalitis, meningitis
 hematological system
 Severe anemia
Respiratory Dyspnea
 Inspiratory dyspnea ____obstruction in large airway
 Three depression sign
 depression in suprasternal fossa, supraclavicular f
ossa, intercostal space
 Expiratory dyspnea____obstruction in small airway or al
veolar elasticity decreased
 Prolonged expiratory time

 Expiratory rhonchi

 Mixed dyspnea____deficient gas exchange

 Respiratory rate increased

 Shallow breathing
Cardiac dyspnea ____ Heart failure

Mechanism of left heart failure

 Pulmo edema diffusion capacity decreased
 Alveolar tension increased stimulating stretch recepto
r excitation of vagus nerve excitation of respirator
y center
 Alveolar elasticity decreased vital capacity decreased
 Increased pressure of pulmo circulation stimulating
respiratory center
Features of left heart failure

 Underlying diseases

 Mixed dyspnea

 Position related dyspnea

 Moist crackles or rhonchi in both lungs

 Relief of symptoms after digitalis, diuretic, vas

odilator agent used
Nocturnal paroxysmal dyspnea

Characteristics
 Awoken due to chest tightness or dyspnea

 Forced sitting position or orthopnea

 Severe sweat

 Tachycardia

 Moist crackles or rhonchi in both lungs

 Pink frothy sputum

Nocturnal paroxysmal dyspnea

Mechanism
 Elevated excitation of vagus nerve
 Contraction of coronary artery myocardium ischemia
 Contraction of bronchiole decreased alveolar ventilation
 Vital capacity decreased in supine position
 Returned blood volume increased pulmo edema
 Sensitivity of respiratory center decreased reaction aft
er obvious hypoxia
Poisoning dyspnea

 Underlying diseases of metabolic acidosis (u

remia, diabetic ketoacidosis )

 deep breathing (Kussmaul breathing)
Dyspnea: accompany signs (1)

 Rhonchi
 Asthma
 Acute left heart failure (cardiac asthma)
 Foreign body in large airway
 Acute laryngeal edema
 Chest pain
 Infection
 Pneumothorax
 Pulmo embolism
 Lung cancer
 Acute myocardial infarct
Dyspnea: accompany signs (2)
 Fever
 Infection
 Cough and sputum
 COPD

 Infection

 Left heart failure

 Unconsciousness
 CNS disorder

 Uremia

 diabetic ketoacidosis
Clubbing finger
Labor pneumonia
Symptoms

 Chill
 Continued fever: 39-40ºC
 Chest pain
 Tachypnea
 Cough
 Rusty sputum
Chronic bronchitis with
emphysema
Symptoms
 Chronic productive cough
 White mucous sputum or pus sputum (infect
ion)
 Usually exacerbation in winter
 Morning cough
 To last more than 3 months
 Exertional dyspnea
 Breathlessness (dyspnea)
 Chest depress
Bronchial asthma
Symptom

 Expiratory dyspnea with wheezing

 Hydrothorax
(pleural effusion)
Symptoms

 300ml: no obvious symptoms

 Dry cough >500ml: breathlessness, chest depress
 Chest pain
 Disappeared with growing of pleural effusion
 Reappeared with the fluid decreasing
 Affected side lying
 Dyspnea, orthopnea, palpitation
 The symptoms of underlying disease
Pneumothorax
Symptoms
 Sudden chest pain
 Dyspnea
 Forced sitting position
 Unaffected side lying
 Dry cough

 Tension pneumothorax
 Progressive dyspnea
 Severe sweat
 Tyckycardia
 Tension, agitated
 Cyanosis
 Respiratory failure
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