1 COUGH, EXPECTORATION AND DYSPNOEA

1.1 COUGH
Acute cough is usually self-limiting
Chronic cough lasts longer than 8 weeks (definition)
Children Adults
Frequent Bronchial hyperresponsiveness
after viral infection
Bronchial asthma
GERD-pulmonary aspiration
Postnasal drip
Chronic bronchitis (smokers)
Postnasal drip
Bronchial asthma
GERD
Congestive left-sided heart failure
Rare Aspiration of foreign body
Bronchiolitis after viral
infection
Cystic fibrosis
Primary ciliary dyskinesia
ACE inhibitor
Recurrent aspiration bronchial cancer
Tuberculosis
Bronchiectasis
Pneumonia
Interstitial lung disease
Psychogenic

1.2 EXPECTORATION
Pathophysiology:
I. Injury to bronchial tree or lung parenchyma sputum production
a. Inhaled noxious substances
b. Inflammation bronchi (bronchitis, asthma, bronchiectasis), lung parenchyma
(pneumonia)
Colour Diagnosis:
I. Clear, white gray sputum
a. Pulmonary oedema clear, white or pink frothy sputum
b. Viral RTI clear to white
c. Chronic bronchitis clear to gray
d. Asthma white to yellow (thick)
II. Yellow
a. Acute bronchitis white to yellow
b. Acute pneumonia white to yellow
c. Asthma white to yellow (thick)
III. Green
a. Pneumonia white, yellow or green
b. Lung abscess green, sudden accumulation of large amount of sputum if abscess
ruptures
c. Chronic bronchitis clear, grey to green (infection)
d. Bronchiectasis, cystic fibrosis green
IV. Brown and Black
a. Chronic bronchitis
b. Chronic pneumonia
c. Coal workers pneumoconiosis
d. Tuberculosis
e. Lung cancer
V. Red, pink and rust-coloured
a. Pneumococcal pneumonia
b. Lung cancer
c. Tuberculosis
d. Pulmonary embolism
1.3 HAEMOPTYSIS
Pathophysiology:
I. Minor haemoptysis: small about of blood mixed with sputum from injured haemorrhagic
mucous membrane
II. Major haemoptysis: frank blood from bursting of a bronchial artery
a. Localise origin of bleeding to determine further treatment
b. Risk of asphyxia dependent on bleeding severity
Aetiology:
Common causes: bronchial carcinoma, bronchiectasis, chronic bronchitis, tuberculosis, aspergilloma,
lung abscess, pulmonary embolism, mitral stenosis
Rare causes: foreign body, aortic aneurysm, Wegener granulomatosis and other vasculitides,
bronchial cysts, atrioventricular malformations, pulmonary endometriosis

Investigations:
Computed tomography
Bronchoscopy

1.4 DYSPNOEA
Degree of dyspnoea:
Grade 0: dyspnoea only during strenuous exercise
Grade 1: dyspnoea only caused by brisk walking
Grade 2: brisk walking not possible due to shortness of breath
Grade 3: stopping due to dyspnoea after 100 m walking
Grade 4: does not leave the house due to shortness of breath
Aetiology:
I. Pulmonary
a. Obstructive
i. Increased airway resistance caused by stenosis of upper airways
ii. Bronchial asthma
iii. Chronic obstructive lung disease
b. Restrictive
i. Infiltrative pulmonary diseases
ii. Pulmonary fibrosis
iii. Post-lung resection
c. Vascular
i. Pulmonary embolism
ii. Pulmonary arterial hypertension
iii. Intrapulmonary right-left shunt
II. Extra-pulmonary
a. Restrictive
i. Excessive obesity
ii. Kyphoscoliosis
iii. Neuromuscular diseases
iv. Diaphragmatic paralysis
b. Cardiovascular diseases
i. Systolic and/or diastolic impairment of ventricular function
ii. Valvular heart diseases
c. Other causes
i. Hypobaric hypoxia
ii. Extreme anaemia
iii. Metabolic acidosis
iv. Third trimester of pregnancy
v. Impairment of breathing regulation (panic attack with hyperventilation,
idiopathic alveolar hypoventilation)
1.4.1 Respiratory Failure
Respiratory Failure Type I: hypoxaemia and normal or low levels of CO2
Respiratory Failure Type II: hypoxaemia and increase in Pco2
Differentiation of causes:
I. If Po2 increases minimally shunt
II. If Po2 increases promptly ventilation-perfusion mismatch, diffusion impairment,
alveolar hypoventilation