Wheezes

Wheezes are continuous musical adventitious lung sounds. It occurs due to airway narrowing either to spasm or endoluminal or extraluminal obstruction. It occurs when air flows rapidly through a narrow airway (bronchospasm, thick secretions, edema), causing fluttering of the airway wall at one or more sites. Always signifies bronchi & upper airway obstruction, it may be heard by an unaided ear or with stethoscope.

Causes of wheezy chest:

• Generalized (Bronchial Asthma, COPD, Bronchitis, Trachiobronchitis, Bronchiolitis, Bronchiectasis, Cystic Fibrosis, Allergic Bronchopulmonary Aspergillsis, Carcinoid Tumor, Left Sided Heart failure [Cardiac Asthma], Uremia [Renal Asthma] & Anaphylaxis)
• Localized [Localized bronchial Obstruction]

1. Intraluminal (Foreign body Inhalation, Bronchial Obstruction by mucus plugs, Bronchial Carcinoma, Carcinoid Tumor & Endobronchial TB)
2. Lumenal (Bronchial Stenosis & Stricture)
3. Extralumenal (Compression by enlarged lymph node or mediastinal mass) 

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspnea
6. Chest pain

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Dyspnea

Dyspnea is a subjective complaint by the patient feeling or consciousness of difficulty in breathing concerning the rate, depth or rhythm. It is a symptoms that can be expressed as:

• Difficult of breathing
• Difficult or laboured breathing
• Undue awareness of breathing 
• Need to breath more
• Uncomfortable or unpleasant breathing

Grading of dyspnea:

Two scoring systems can be adopted to evaluate the dyspnea changing it from subjective complaint to objective event.

• American Thoracic Society Score (ATS)

Grade	Description
0	No breathlessness except with strenuous exercise
1	Breathlessness when hurrying on the level or walking up a slight hill
2	Walk slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at town pace on the level
3	Stop for breath after walking about 100 yards (96 meter) or a few on the level
4	Too breathless to leave the house or breathless when dressing or undressing

• New York Heart Association Score (NYHA)

Grade	Description
1	Dyspnea on more than ordinary activity
2	Dyspnea on ordinary activity
3	Dyspnea on less than ordinary activity
4	Dyspnea on rest

The interpretation of dyspnea includes the following points:

• Onset:-

1. Within minutes or hours [Acute, i.e. Dyspnea as in emergency] (Acute attack of Asthma, Pulmonary Edema, Tension Pneumothorax, Acute Massive Pulmonary Embolism, Pneumonia & Sizable foreign body Aspiration)
2. Within days or weeks (Cardiac Failure, Thrombo-embolic Disease, Pleural Effusion, Anemia & Hyperthyroidism) 
3. Within months or years (COPD & Pulmonary Hypertension)

• Course:-

1. Progressive (Interstitial Pulmonary Fibrosis, Pulmonary Hypertension, COPD, Cardiomyopathy)
2. Intermittent (Bronchial Asthma) 

• Relation to time:-

1. Nocturnal [At night] (Bronchial Asthma, Cardiac Asthma & Obstructive Sleep Apnea)

• Relation to posture:-

1. Orthopnea [On lying down] (Left Sided Heart failure, Acute Asthma, Mediastinal Syndrome, Tense Ascites, COPD, Bilateral phrenic nerve paralysis)
2. Platypnea [On upright position] (Multiple recurrent Pulmonary Emboli, Bibasilar Pneumonia, Bilateral Pleural Effusion, Bibasilar arteriovenous shunt & Pulmonary arteriovenous malformation)
3. Talepnea [On lying lateral side] (Unilateral Lung & Pleural Disease:- Unilateral Pleural Effusion, Tension Pneumothorax, Destroyed lung & Atelectatic-Consolidated Lung)

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspnea
6. Chest pain

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Expectoration

Expectoration entails the passage of sputum out of the respiratory tract, excluding saliva. The interpretation of expectoration includes the following points:

• Onset:- 

1. Acute (Acute Bronchitis, Pneumonia, Acute Abscess & Empyema with bronchopleural fistula)
2. Gradual (TB, Chronic Bronchitis & Bronchiectasis) 

• Course:-

1. Progressive (Infection uncontrolled by antibiotics)
2. Regressive (Spontaneous improvement or good response to the antibiotics used)
3. Intermittent (Chronic Bronchitis & Bronchiectasis) 

• Duration:-

1. Long duration (Chronic Bronchitis & Chronic Lung Abscess)
2. Short duration (Acute Bronchitis, Pneumonia & Acute Lung Abscess) 

• Amount:- Big amount = >100 cc (bronchorrhea), due to Chronic Suppurative Lung Diseases which are:

1. Bronchiectasis
2. Chronic Lung Abscess 
3. Infected Cystic Lung
4. Empyema with Bronchopleural Fistula 

It also may be due to: Chronic Bronchitis, Asthma, Alveolar Cell Carcinoma & Acute Organophosphorous Poisoning 

• Colour:- It may be diagnostic:

1. Greenish (Infection with gram negative organism e.g. Pseudomonas due to formation of pyocyen pigment)
2. Rusty (Golden brown sputum due to altered haemoglobin in Stretococcal Pneumonia)
3. Red Current Jelly (Klebsiella Pneumonia & Bronchial Adenoma)
4. Haemoptysis (Bloody sputum)
5. Anchovy Sauce (Chocolate coloured sputum in Amoebic Lung Abscess)
6. Black (Melanoptysis in smokers, coal workers pneumoconiosis & Mucormycosis)
7. Reddish Tinge (Aerosolized brochodilators, Serratia Marcens Pneumonia & Secondary inhalation of iron oxide in glass sanders)
8. Blue (Copper miners)
9. Watery (Alveolar Cell Carcinoma)
10. Tricoptysis (Cough of hair due to rupture of dermoid cyst into a bronchus)
11. Chalky material/small stones (Broncholithiasis which is due to prior infections with TB, Histoplasmosis or Coccidiodomycosis)

• Aspect:-

1. Frothy sputum in Pulmonary Edema
2. Purulent sputum in Suppurative Lung Disease
3. Thick mucoid pellets in Bronchial Asthma 

• Odour (smell):-  It may be diagnostic:

1. Offensive putrid (Anaerobic organism infection in Suppurative Lung Disease)
2. Distinctive (Gram negative infection, similar to E-coli on a culture medium)

• Relation to time:-

1. Day (Morning cough of smokers or Suppurative Lung Disease)
2. Night (Bronchial Asthma, Cardiac Asthma or Acute Pulmonary Edema) 
3. Variable Morning or Nocturnal (Bronchial Asthma)
4. All over the day

• Relation to posture:- Only in Suppurative Lung Disease

1. Leaning forward or praying in Bronchiectasis
2. Lying on healthy side in Chronic Lung Abscess 

• Associated haemoptysis

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspnea
6. Chest pain

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Cough

Batuk adalah gejala yang paling biasa dialami oleh pesakit paru-paru. Pesakit dianggap mengalami batuk kronik apabila dia mengalami gejala ini lebih dari 3 minggu. Selain itu, batuk juga dikelaskan kepada: batuk kering & batuk produktif.

• Dry Cough: mungkin berlaku disebabkan oleh masalah pernafasan atau bukan masalah pernafasan
• Productive Cough (with sputum): hanya berlaku disebabkan oleh masalah saluran udara (pernafasan)

Di samping itu, terdapat beberapa ciri-ciri batuk yang penting untuk dikenal pasti bagi mencapai diagnostik penyakit, seperti:

Sebab-sebab Batuk Kering

A) Masalah Pernafasan:

1. Acute Upper & Lower Respiratory Tract Infection: (Selsema, Acute Rhinitis & Sinusitis, Acute Pharyngitis, Acute Bronchitis, Tracheitis & Tracheobronchitis dan Pneumonia)
2. Reactive Airway Dysfunction Syndrome: (Peningkatan kereaktifan saluran pernafasan mengakibatkan batuk kering berterusan, disebabkan oleh jangkitan virus)
3. Bronchial Asthma
4. TB
5. Foreign Body Inhalation 
6. Pleural Disease
7. Interstitial Lung Diseases & extrinsic Allergic Alveolitis
8. Lung Congestion 
9. Pulmonary Embolism
10. Mediastinal Mass
11. Bronchial Adenoma & Bronchial Carcinoma

B) Bukan Masalah Pernafasan:

1. Gastroesophageal Reflux Disease (GERD)
2. Central causes
3. Reflex
4. Drug Induced
5. Psychogenic Cough  

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspneoa
6. Chest pain

[Continue reading...]