0071643192.pdf

THORACIC AND RESPIRATORY

DISORDERS

SIGNS AND SYMPTOMS

Cough

CAUSES

Cough results from stimulation of irritant receptors in the larynx, trachea, and
major bronchi. Triggers include mucus, allergens, gastric acid (and more).
Likely etiologies differ depending on whether the cough is acute or chronic
(>3-week duration).

Acute Cough

■ Acute upper respiratory infection (most common)
■ Lower respiratory infection
■ Postnasal drip (rhinitis, sinusitis)
■ Asthma/COPD exacerbation
■ Airway foreign body
■ CHF
■ Aspiration (disordered swallow)

Chronic Cough

■ Chronic bronchitis/smoking
■ Postnasal drip (rhinitis, sinusitis)
■ GERD
■ Asthma
■ ACE inhibitor
■ Think about Bordetella pertussis.
■ Other causes include bronchiectasis, CHF, environmental irritants, and
aspiration.

SYMPTOMS/EXAM

■ Inquire about postnasal drip symptoms, asthma, GERD, treatment with
ACEIs, and smoking.
■ Determine if cough is productive (infection, bronchiectasis) or bloody
(malignancy, infection, Goodpasture syndrome, Wegener granulomatosis).
■ The physical exam should focus on the nasal mucosa, lungs, heart, and ex-
tremities (for clubbing).

DIAGNOSIS/TREATMENT

■ Evaluation should be guided by history and exam findings (eg, CXR if
abnormal lung sounds).
■ Treatment should be geared to underlying cause.

Dyspnea

Dyspnea is the uncomfortable awareness of difficult, labored, or unpleasant
breathing. Normal resting patients are unaware of the act of breathing. For
most patients presenting with dyspnea, there is either a cardiac or pulmonary
cause of their symptoms (see Table 10.1). Other, less common, causes
include psychogenic factors, GERD, and deconditioning.

SYMPTOMS/EXAM

Look for signs of impending respiratory failure (severe tachypnea/tachycardia,
stridor, agitation) and evidence for underlying etiology (eg, rash and hypoten-
sion with anaphylaxis).