Macloed's respiratory Flashcards
(13 cards)
What questions should we ask about breathlessness
Onset?
how is breathing at rest and overnight?- asthma wakes patients at night, COPD are comfortable at rest and when asleep but bad with exertion.
Positional changes?- orthopnoea- heart failure , severe airflow obstruction or diaphragmatic weakness because the weight of the abdominal contents displaces the diaphragm towards the head on lying down, composing the vital capacity.
is breathing normal some days?- variability is a hallmark of asthma while consistent daily limitation is typical in COPD.
Assessment of disability and disease impact`?- tell me something that can make you breathless, how far can you walk on a good day?
when does the breathlessness come on?- asthma induced after exercise, during early recovery phase, because sympathetic drive during exercise defends airway patency.
What is suggestive of a psychological aetiology of breathlessness
‘I feel that I can’t get enough air’
accompanied by a normal vital capacity
associated symptoms induced by hypocapnia in hyperventilation included digital and personal parasthesiae, lightheadedness and sometimes chest tightness.
Outline the MRC breathlessness scale
1- not troubles by brealtnessness except on strenuous exercise
2- short of breath when hurrying on the level or running up a hill
3- walks slower than most people on the level, stops after a mile or so, or stops after 15 mins walking at own pace
4- stops for breath after walking 100 yards or so, or after a few minutes on level ground
5- too breathless to leave the house, or breathless on undressing.
What is a wheeze
Wheeze describes the high-pithced musical or ‘whistling’ sounds produced by turbulent air flow through small airways narrowed by bronchospasm and/or airway secretions.
When are wheezes most commonly heard
During expiration, when airway calibre is reduced.
What must a wheeze be distinguished from
Rattling inspiratory and expiratory sounds caused by loose, mobile secretions in the upper airways.
Louder, dramatic croak caused by stridor caused by obstruction of the trachea and large airways.
Describe the importance of identifying wheeze
Typical of small airways disease. Most commonly associated with asthma and COPD but can also occur with acute respiratory tract infection or with exacerbations of bronchiectasis (due to combination of airway narrowing and excessive secretions).
What questions should we ask about wheeze
Worse during or after exercise? if it occurs during exercise and limits it- COPD in asthma- wheeze and tightness usually appear after exercise
Do you wake with the wheeze at night?- Asthma,
do you hay fever or other allergies?- atopy is common in allergic asthma, family history of wheeze is common in asthma
Is it worse on waking in the morning and relieved by clearing sputum?- common in COPD
Do you smoke?- suggestive of COPD, though patients with asthma occasionally smoke
Are there daily volumes of yellow or green sputum, sometimes with blood? suggests bronchiectasis.
What is the cough reflex
Evolved to dislodge foreign material and secretions from the central airways and may be triggered by pathology at any level of the bronchial tree. Inspiration is followed by an expiratory effort against a closed glottis. Subsequent sudden opening of the glottis with rapid expiratory flow produces the characteristic sound.
What questions should we ask about cough
Duration
Whether it is present every day
Is it intrusive/irresistible or whether the patient coughs deliberately to clear a perceived obstruction `(throat clearing)
Whether it produces sputum?- if so, how much nd what colour
any triggrers- such as swallowing, in cold air, during exercise
smoking- increases risk of chronic bronchitis or lung cancer.
Associated clinical features:
wheeze- may signal cough-variant asthma
heartburn or reflux- GORD commonly triggers cough
altered voice or swallowing- consider laryngeal causes
DRUG HISTORY- ACEi
What is cough most commonly a symptom of
acute viral upper respiratory tract infection, which are usually self-limiting over days to weeks
What may be causing coughs that fail ti settle of a couple of weeks
may be the presenting feature of a bronchial carcinoma. A history of smoking raises further suspicion of malignancy, although chronic cough is a non-specific symptom in smokers. Other investigations, such as X-ray are often required to exclude early cancer.
chronic cough is defined as cough lasting more than 8 weeks and can be debilitating both physically and socially.
What may happen in patients with malignancy at the left hilum
In patients with malignancy at the left hilum, damage to the recurrent laryngeal nerve may paralyse the left vocal cord, making it impossible for the patient to close the glottis and generate a normal expulsive cough. The resulting hoarse forced expiration without the initial explosive glottal opening is termed a ‘bovine cough’ and is an important symptom warning of Hilar malignancy.
