Symptoms of bronchopulmonary diseases

Cough
Breathlessness
Haemoptysis
Pain in chest
 
The most common physical findings of illness of respiratory tract

The most characteristic symptoms of diseases of the respiratory system are: cough, breathlessness, haemoptysis, and chest pain.
 
Cough
 
it is a protective reflex of an organism arising from irritation of respective parts of respiratory tract and pleura, which can be manifested as:
 
Dry (unproductive) - usually irritating, persistent, arises from tracheitis, acute bronchitis, pleuritis, during inhalation of irritating gases, and in bronchogenic carcinoma.
 
Wet (productive) with mucous expectoration:
 

	Serous sputum - thin mixed with blood, in lung oedema (pinkish);
	Mucous sputum - mostly viscous, at the beginning of acute bronchitis, in asthmatic attack
	Pus-mucous sputum - yellowish, yellow-greenish, occurs in chronic bronchitis, bronchiectasia, and tuberculosis
	Putrescent sputum – smelling putridly, present in lung abscess or gangrene
	Sanguinolent sputum - with presence of blood, occurs in bronchiectasia, bronchogenic carcinoma (raspberry-coloured), or pneumonia (croceum)

 
Breathlessness
 
It is a subjective feeling of air deficiency, which may not express any objective sign.
 
Physiologically it is caused by an excessive physical activity, pathologically it is related to many diseases:
 

	Obstructive breathlessness - is caused by an obstruction in respiratory tract (mucus), by spasm (chronic obstructive bronchopulmonary disease, bronchial asthma)
	Restrictive breathlessness - is associated with infiltrative processes (bronchopneumonia) or compression by pleural effusion, eventually atelectasis
	Other reasons of breathlessness - metabolic disorders (diabetic coma, uraemia), heart diseases.

 
According to clinical manifestation the following types of breathlessness can be recognised:
 

	Inspiratory breathlessness - with more difficult inspiration (aspiration of foreign body, stenosis of larynx, compression of trachea and bronchi)
	Expiratory breathlessness - with markedly prolonged expiration (bronchial asthma).

 
Abnormal breathing with stridor (severe inspiratory or expiratory breathlessness) accompanied by loud wheezy sounds can be caused by spasm (stenosis) of great airways, oedema, foreign body, or outside compression (carcinomas, enlarged thyroid gland).
 
Haemoptysis
 
means expectorating of blood when minor or major vessels of respiratory tract are damaged. Massive bleeding is life-threatening condition. The most common reasons are:
 

	Bronchopulmonary - bronchogenic carcinoma, tuberculosis, bronchiectasia, chronic bronchitis
	Cardiac - mitral stenosis, congenital heart defects, vascular malformation, lung infarction
	Haematological - haemorrhagic diathesis, unadjusted anticoagulation therapy.

 
When doing differential diagnostics it is essential to exclude possible bleeding from nose, oral cavity, and nasopharynx. Also haematemesis (although semi-digested blood has got brownish colour) can make decision making difficult.
 
Chest pain
 
related to bronchopulmonary diseases occurs relatively rarely (sensitive innervation of lungs and visceral pleura is missing). Difficulties are caused by affection of parietal pleura.
 

	Pleural pain - is manifested by a strong sharp pain connected to breathing and cough (dry pleuritis, lung infarction, bronchopneumonia with pleural reaction)
	Tracheal pain - is characterised by intensive stinging, retrosternal pain in acute phase of illness (diagnostically essential to exclude myocardial infarction)
	Tumorous pain - caused by the tumour in growing into the brachial plexus (Pancoast tumour is a peripheral form of bronchogenic carcinoma). It is manifested by intensive shoulder pain with irradiation into the arm.

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