Surgery II EXIMIUS

Approach To The Patient With Disease Of The Respiratory System 2021

Ma. Raul Estrella Combate, MD September 2019

Three Major Categories of Respiratory Diseases THE CARDINAL SYMPTOMS OF RESPIRATORY DISEASE ARE
1. Obstructive Lung Diseases DYSPNEA AND COUGH.
− Most common and primarily include disorders of the airways,
such as COUGH
1. Asthma
 Generally indicates disease of the respiratory system.
2. Chronic obstructive pulmonary disease (COPD)
 Clinician should inquire about the duration of the cough,
3. Bronchiectasis
whether or not it is associated with sputum production and any
4. Bronchiolitis
specific triggers that induce it.
 Is a reflex action to expel air suddenly and noisily from the
2. Restrictive Disorders
lungs through the glottis, either as the result of an
− Diseases resulting in restrictive pathophysiology include
involuntary muscular spasm in the throat or to clear the air
1. parenchymal lung diseases,
passages.
2. abnormalities of the chest wall and pleura
 Coughing may result if your airways are irritated by
3. neuromuscular disease.
infections or allergens.
Acute cough Chronic cough
3. Abnormalities of the Vasculature
− Disorders of the pulmonary vasculature include -productive of phlegm is often -(defined as that persisting for >
1. pulmonary embolism as symptom of infection of the 3 weeks) is commonly
2. pulmonary hypertension respiratory system, including associated with obstructive lung
3. - pulmonary veno-occlusive disease  processes affecting the diseases, particularly asthma
upper airway (e.g sinusitis, and chronic bronchitis, as well as
 Disorders can be also grouped according to gas exchange tracheitis) “nonrespiratory” diseases, such
abnormalities including:  the lower airways (e.g as gastroesophageal reflux and
o Hypoxemic bronchitis, bronchiectasis) postnasal drip.
o Hypercarbic  Lung parenchyma (e.g
pneumonia) - Diffuse parenchymal lung
o Combined Impairment
-Both the quantity and quality diseases, including IPF,
 However, many diseases of the lung do not manifest as gas
of the sputum, including frequently present as a
exchange abnormalities.
whether it is blood streaked or persistent, nonproductive
frankly bloody, should be cough.
CATEGORIES OF RESPIRATORY DISEASE
determined.
CATEGORY EXAMPLES
Obstructive Lung Disease Ashtma
Chronic Obstructive Pulmonary
ADDITIONAL SYMPTOMS
Disease (Copd)
 Patients with respiratory disease may report wheezing, which is
Bronchiectasis
suggestive of airways disease, particularly asthma.
Bronchiolitis
 Hemoptysis can be a symptom of a variety of lung diseases,
Restrictive Pathophysiology Idiopathic Pulmonary Fibrosis(Ipf)
including infections of the respiratory tract, bronchogenic
Parenchymal Disease Asbestosis
carcinoma, and pulmonary embolism.
Desquamative Interstitial
 Chest pain or discomfort is often thought to be respiratory in
Pneumonitis (Dip)
origin.
Sarcoidosis
 Areas of alveolar filling have increased whispered pectoriloquy
Restrictive Pathophysiology- Amyotrophic Lateral Sclerosis (Als) as well as transmission of larger-airway sounds (e.g bronchial
Neuromuscular Weakness Guillain-Barre Syndrome breath sounds in a lung zone where vesicular breath sounds are
Restrictive Pathophysiology- Kyphoscoliosis expected.
Chest Wall/Pleural Disease Ankylosing Spondylitis  Lack or diminution of breath sounds can also help determine
Chronic Pleural Effusions the etiology of respiratory disease.
Pulmonary Vascular Disease Pulmonary Embolism  Patients with emphysema often have a quiet chest with
Pulmonary Arterial Hypertension diffusely decreased breath sounds.
Malignancy Bronchogenic Carcinoma (Non-  Pneumothorax or pleural effusion may present with an area of
Small-Cell And Small-Cell absent breath sounds
Metastatic Disease  Look at the chest area for retraction (heaving chest).
Infectious Disease Pneumonia
Bronchitis Basic laboratory test to request: Chest X-ray
Tracheitis

TRANSCRIBERS Group 9 1
 Surgery II EXIMIUS
Approach To The Patient With Disease Of The Respiratory System 2021
Ma. Raul Estrella Combate, MD September 2019

“whereas patients with congestive heart failure more

GUIDE TO DIAGNOSING COMMON CAUSES OF COUGH: commonly report “air hunger” or a sense of suffocation”.
A. Acute Cough: Less than 3 weeks ○ Acute shortness of breath is usually associated with
Ask and Check: If yes, consider the following sudden physiologic changes such as:
1. Associated with runny Common cold - laryngeal edema
nose, muscle aches and - bronchospasm
pains, feeling tired and - myocardial infarction
low grade fever. - pulmonary embolism or pneumothorax
2. Associated with runny Allergic rhinitis ○ Patients with COPD and idiopathic pulmonary fibrosis (IPF)
nose and exposure to experience a gradual progression of dyspnea on exertion,
offending allergen (e.g. punctuated by acute exacerbations of shortness of breath.
dust, pollen). ○ Difficulty of breathing has a pulmonary or cardiac cause.
3. Associated with Acute bacterial sinusitis ○ History and physical examination strongly suggest a
headache and pain in the particular cause but a chest x-ray can be very helpful.
nasal and frontal area of
the sinuses. COMMON CAUSES
○ Hyperventilation syndrome
4. Associated with fever, Pneumonia
chest crackles and pain ◦ - common and do not need any further work-up
on breathing. ○ Respiratory infection
○ Heart failure need further tests and treatment
5. Known case of asthma. Asthmatic bronchitis
Associated with wheezing ○ Anxiety attacks – due to stressed and patients only need to
and productive phlegm. be reassured
6. Known case of COPD Pneumonia in addition to
WHAT TO ASK FOR IN THE HISTORY
(chronic obstructive lung COPD
1. When did the difficulty of breathing start?
disease) and associated
2. What is the functional capacity of the patient? Can the
with fever.
patient climb 2 flight of stairs?
7. Associated with anxiety Nervous cough
3. Does the patient have history of asthma, hypertension,
and stress.
heart disease, or weak lungs (tuberculosis)?
4. Does the patient smoke? Is there exposure to
B. Chronic Cough: More than 3 weeks environmental pollution or occupational hazards such as
Ask and Check: If yes, consider the following: paints, thinners, dust and other chemicals?
1. Associated with runny Post-nasal drip syndrome 5. Does the patient have fever, cough, phlegm or wheezing?
nose and exposure to (allergic rhinitis) 6. Does the patient have chest pains? If yes, are these pains
allergic substances. aggravated by movement (muscle pain), breathing
2. Associated with Chronic bacterial sinusitis (pulmonary cause) or is it a substernal deep pain (heart
headache and pain in the cause)?
nasal and frontal area of
the sinuses. WHAT TO CHECK FOR IN THE PHYSICAL EXAMINATION?
3. Known case of asthma Asthma 1. Check the vital signs: Blood pressure, heart rate,
and associated with respiratory rate and temperature.
wheezing during attacks. 2. Check for chest retractions and use of accessory neck
4. Known case of COPD, COPD in exacerbation muscles for breathing?
chronic smoker and 3. Listen to the chest area for crackles and wheezes?
productive phlegm. 4. Listen to the heart for extra gallops or murmurs?
5. Associated with intake of Ace-inhibitor cough, shift the
ace-inhibitors (drugs drug to an angiotensin- BASIC LABORATORY TESTS TO REQUEST
ending in “pril”). receptor blocker. 1. Chest X-ray (PA-lateral)
6. Associated with Gastroesophageal reflux 2. Electrocardiogram
heartburn and upset disease 3. Complete blood count
stomach. 4. Check pulse oximeter
7. History of tuberculosis Check for tuberculosis
8. History of heavy smoking Check for lung cancer

DIFFICULTY OF BREATHING (DYSPNEA)

○ Has many causes, some of which are not predominantly
due to lung pathology.
○ The words a patient uses to describe shortness of breath
can suggest certain etiologies for dyspnea.
○ Patients with obstructive lung disease often complain of
“chest tightness” or “inability to get deep breath

TRANSCRIBERS Group 9 2
 Surgery II
Approach To The Patient With Disease Of The Respiratory System
Ma. Raul Estrella Combate, MD
GUIDE TO DIAGNOSING COMMON CAUSE OF DIFFICULTY OF BREATHING
Ask and check:
1. Guide to diagnosing
common cause of
difficulty of breathing
2. Presence of fever, cough
and yellow phlegm but
normal chest findings.
3. Presence of fever, cough,
yellow phlegm and lung
crackles.
4. Presence of wheezes.
History of asthma and
allergy.
5. Heavy smoker, middle
aged male and long
history of difficulty of
breathing.
6. Presence of afternoon
fever, chronic cough and
back pain.
7. Patient cannot lie flat on
bed, has history of heart
disease or hypertension,
ad with heart
abnormalities.
8. Presence of direct pain
on touching the chest
area.
9. Presence of swelling of
one leg but can lie flat on
bed.
10. Presence of fever, neck,
inflammation,
hoarseness.
11. Cannot lie flat on bed,
with poor urination and a
history of kidney disease.
TRANSCRIBERS Group 9
EXIMIUS
2021
September 2019
Ask and check:
Hyperventilation syndrome.
Give assurance and sedatives
if needed
Upper respiratory infection.
Give antibiotics.
Consider pneumonia. Rarely
pleural effusion. Request
Chest X-ray and give
antibiotics.
Bronchial asthma. Treat
asthma.
Chronic obstructive lung
disease. Request Chest X-ray
to confirm.
Consider Tuberculosis.
Request for Chest X-ray
Consider heart failure.
Request for Chest X-ray, ECG,
and 2D-Echo
Consider musculoskeletal
chest pain. Give pain relievers.
Rule out pulmonary
embolism. Request for Chest
X-ray, ECG, ABG initially.
Consider upper airway
obstruction. Get emergency
ENT referral.
Rule out kidney failure.
Request for CBC, Creatinine,
Serum Potassium, Chest X-ray,
and ECG.
3