Typical spectrum of respiratory complaints
When examining a patient with suspected respiratory system pathology, attention must first be paid to basic symptoms. In clinical practice, there are four main complaints:
- Cough. Its nature must be clarified: it can be dry (non-productive) or wet (productive, accompanied by sputum production).
- Hemoptysis. An alarming symptom that requires immediate detailing.
- Dyspnea. A sensation of air hunger that can occur at rest or during physical exertion.
- Chest pain. An important sign that must be differentiated from cardiac pathology.
Correlation of symptoms with the disease course
The severity of clinical manifestations directly depends on the form in which the disease occurs.
In acute processes, all the symptoms listed above are usually pronounced. The patient clearly formulates complaints, which significantly facilitates primary diagnosis.
A completely different picture is observed in chronic processes. In the early stages of the disease, as well as during periods of remission, clinical manifestations may be minimal or completely absent. The main consequence of this feature is the extreme difficulty of timely diagnosis. Identifying chronic pathology at the stage of apparent well-being is possible only through targeted examination.
Upper respiratory tract and vocal apparatus
Competent history taking and general physical examination should not be limited only to the chest. The physician must actively identify symptoms of upper respiratory tract involvement.
Special attention is paid to nasal breathing. It should be ascertained whether the patency of the nasal passages is impaired and whether the patient experiences epistaxis. If such pathology is detected, a consultation with an ENT specialist is mandatory.
An extremely informative sign is a change in the patient's voice:
- Nasal tone ("nasal speech"): directly indicates a pathological process in the nasal cavity or nasopharynx.
- Hoarseness (dysphonia): the voice becomes low, rough, and wheezy.
Causes of dysphonia
Hoarseness can have various origins. The main groups of causes:
- Inflammatory and functional: occur against the background of acute infections or routine vocal cord strain.
- Mechanical and neoplastic: associated with diseases directly affecting the larynx.
- Neurological: caused by compression of the recurrent laryngeal nerve (n. laryngeus recurrens). Most often, compression occurs due to tumors or infiltrates located in the neck or mediastinum.
Briefly: answers to topical questions
What types of dyspnea are distinguished based on their relationship with respiratory phases?
Depending on the relationship with respiratory phases, three main types of dyspnea are distinguished.
- Inspiratory dyspnea — difficulty in inspiration, the localization of the obstruction is in the upper respiratory tract (vocal cord edema, tumor, foreign body).
- Expiratory dyspnea — difficulty in expiration, occurring in pulmonary emphysema or bronchospasm.
- Mixed dyspnea — a combination of signs of difficult inspiration and expiration.
What are the characteristics of chest pain in pleural lesions?
Chest pain in pleural involvement is characterized by high intensity and clear localization.
- Character — acute, stabbing, intense.
- Localization — the patient can precisely indicate the site of maximum pain.
- Trigger factors — sharp intensification at the height of a deep breath, during coughing, and when bending the body to the healthy side.
- Irradiation — shoulder, epigastric region.
- Pain relief — lying on the affected side, chest immobilization, or shallow breathing.
Which respiratory system diseases are most frequently accompanied by hemoptysis?
Hemoptysis is most frequently accompanied by infectious-inflammatory processes, chronic, and oncological lung diseases.
- Infectious-inflammatory processes — acute pneumonia (especially lobar pneumonia), lung abscess and gangrene, pulmonary tuberculosis, acute viral respiratory infections.
- Chronic lung diseases — bronchiectasis, including "dry" bronchiectasis.
- Oncological diseases — lung cancer (predominantly bronchogenic).
Mechanical factors, such as foreign bodies in the bronchi or vascular rupture during exhausting coughing, can also be the cause.
The mnemonic abbreviation CCED (Cough, Dyspnea, Hemoptysis, Chest pain) helps remember the main complaints.
Class and exam questions
Why are chronic lung diseases often diagnosed late?
In chronic courses during early stages or in the remission phase, symptoms are often absent or minimally expressed. Without targeted examination, a patient may not seek medical help for a long time.
What does an acquired nasal tone in a patient's voice indicate?
If the patient begins to speak with a nasal tone, this is a direct indication of nasopharyngeal or nasal cavity pathology that disrupts normal nasal breathing.
What neurological causes can cause hoarseness?
Dysphonia (hoarse, rough voice) may occur due to compression of the recurrent laryngeal nerve (n. laryngeus recurrens) by tumor masses or infiltrates in the neck and mediastinum.
What else to study on this topic
- Differential characteristics of dry and wet cough
- Anatomy and topography of the recurrent laryngeal nerve (n. laryngeus recurrens)
- Indications for referring a patient to an ENT specialist
- Features of history taking with suspected mediastinal pathology
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