Clinical features of the diseases

asthma
Consist of a triad of:
Dyspnea
Cough
Wheezing

In most typical form all 3 symptoms coexist

 Onset of attack:
Patient experience a sense of constriction in the
chest with non-productive cough
Respiration: audibly harsh, wheezing in both phases
of respiration becomes prominent
Expiration: prolonged
Frequently have tachypnea, tachycardia and mild
systolic hypertension
Lungs: become overinflated, AP diameter increases
 Severe/prolonged attack
May have loss of adventitial breath sounds
Wheezing becomes very high pitched
Accessory muscle becomes visibly active
Paradoxical pulse often develops
 End of episode
Frequently marked by a cough that produces
thick, stingy mucus
Wheezing is lessened in extreme situations
Cough may be ineffective and a gasping type of
respiratory pattern may begin
This imply extensive mucus plugging and impending
suffocation
 Less typical
Patient may complain of intermittent episodes
of non-productive cough or exertional dyspnea

Tend to have normal breath sounds when

examined during symptomatic periods but may
wheeze after repeated forced exhalations
 Difference of asthma from other diseases
with dyspnea and wheezing:

Physical findings and symptoms

History of periodic attacks
Personal and family history of allergic diseases
Nocturnal awakening with dyspnea and/or
wheezing
Most common and so prevalent that absence of
which produces doubt about diagnosis
Timing:
Acute episodes, separated by symptom free periods. Nocturnal
episodes common
Aggravating factors:
Variable, including allergens, irritants, respiratory infections,
exercise and emotions
Relieving factors:
Separation from aggravating factors

Symptoms:
Wheezing, cough, tightness in chest

Setting:
Environmental and emotional conditions
Lung cancer
Cough is dry to productive
Sputum may be blood streaked or bloody
Setting is usually a long history of cigarette
smoking
Major presenting complaints:
Cough: 75%
Weight loss: 40%
Chest pain: (40%)
Dyspnea: 20%
 Signs and symptoms are caused by:
Local growth of tumor
Invasion and obstruction of adjacent structures
Growth in regional nodes

Central or endobronchial growth:

Cough and hemoptysis
Wheeze and stridor
Dyspnea
Post obstructive pneumonitis
 Peripheral growth:
Pain from pleural effusion
Cough, dyspnea
Symptoms of lung abscess resulting from lung
cavitation

Regional spread
Tracheal obstruction
Esophageal compression with dysphagia
Recurrent laryngeal nerve paralysis or hoarseness
Phrenic nerve paralysis with elevation of
hemidiaphragm and dyspnea
Sympathetic nerve paralysis with Horners syndrome
 Malignant pleural effusion often leads to
dyspnea

Pancoasts syndrome
Results from local extension of a tumor growing
in the apex of the lung with involvement of the
8th cervical and 1st and 2nd thoracic nerves
Shoulder pain that radiates in the ulnar
distribution of the arm
Radiologic destruction of the 1st and 2nd rib

Often Horners and Pancoasts coexist.

 SVC syndrome
From vascular obstruction
Pericardial and cardiac extension with resultant
tamponade, arrhythmia or cardiac failure
Lymphatic obstruction with resultant pleural
effusion
Lymphangitic spread through the lungs with
hypoxemia and dyspnea

Paraneoplastic syndrome
Common in patients with lung cancer and may be
the presenting finding or first sign of recurrence
 Skeletal
Include clubbing in 30% of cases
Hypertrophic pulmonary osteoarthropathy 1-10%
cases

Extrathoracic metastatic disease

Found in autopsy in >50% patients with squamos
carcinoma

Neurologic myopathic syndromes

Seen only in 1% of patients but are dramatic and
include the myasthenic eaton-lambert syndrome
and retinal blindness with small cell cancer
emphysema
Clinical manifestation do not occur until at
least 1/3 of the functioning pulmonary
parenchyma is damaged.
Dyspnea
Usually the first symptom
Cough/wheezing
Chief complaints in some patients
Cough/expectoration
Variable and depend on the extent of associated
bronchitis
Weight loss
Common and can be severe as to suggest a malignant
tumor
 Patient is:
Barrel-chested
Dyspneic with obviously prolonged expiration
Sits forward in a hunched over position
Breathes through pursed lips

With severe emphysema:

Cough is often slight
Overdistention is severe
Diffusion capacity is low
Blood gas volume are relatively normal at rest
Chronic bronchitis
Persistent cough productive of sputum is the
cardinal symptom
Dyspnea may eventually develop on exertion
Other elements of COPD may develop with
continued smoking such as:
Hypercapnia
Hypoxemia
Mild cyanosis

Referred to as blue bloaters due to the

presence of marked cyanosis and fluid retention
Timing:
Chronic productive cough followed by slowly progressive
dyspnea
Aggravating factors:
Exertion, inhaled irritants, respiratory infections

Relieving factors:
Expectoration, rest, though dyspnea may become persistent

Symptoms:
Chronic productive cough

Setting:
History of smoking, air pollutants, recurrent respiratory
infections
 Chronic bronchitis Emphysema

Age 40-45 50-75

Dyspnea Mild; late Severe; early

Cough Early; copious sputum Late; scanty sputum

Appearance Blue bloaters Pink puffer

Infection Common Occassional

Respiratory insufficiency Repeated Terminal

Cor pulmonale Common Rare:terminal

Airway resistance Increased Normal or slightly increased

Elastic recoil Normal low

Chest radiograph Prominent vessels; large Hyperinflation; small heart

heart