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SIGNS AND SYMPTOMS OF
RESPIRATORY DISEASES
LEARNING OBJECTIVES:
By the end of this session, students should be able to:
 Enumerate the various symptoms of respiratory
disorders.
 Enumerate the different signs ellicitied after a clinical
examination of a patient with respiratory disorders.
 Correlate the symptoms with the signs of respiratory
distress.
 Determine the cause of respiratory distress in a patient
with particular sign or symptom
• The techniques of examination
• Be able to correlate the findings with common diseases
SYMPTOMS
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Cough
Breathlessness / dysnea
Chest pain
Hemoptysis
Syncope
Palpitations
Weight loss
Fatigue
SIGNS
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Tachypnea
Tachycardia
Cachexia
Wheezing
Sputum
Use of accessory muscles of respiration
Decreased chest expansion
Vocal Resonance
Decreased breath sounds
crepitations
COUGH
• To expel air suddenly and noisily from the lungs through the
glottis, either as the result of an involuntary muscular spasm in
the throat or to clear the air passages
CAUSES:
• Asthma
• Allergies
• COPD (chronic obstructive pulmonary disease)
• GERD (gastroesophageal reflux disease)
• Smoking
• Throat disorders, such as croup in young children
• Some medicines
SPUTUM
Sputum is matter that is expectorated from the respiratory
tract, such as mucus or phlegm, mixed with saliva
Types and causes:
– Serous e.g., Pulmonary edema
– Mucous e.g., chronic bronchitis, COPD, asthma
– Mucopurulent (brown, yellow, green) e.g., Infection
– Rusty e.g., pneumococcal pneumonia
BREATHLESSNESS

Shortness of breath; difficult or labored breathing.
Associated sign:
Tachypnea (increased respiratory rate)
o Normal: 12/min
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CAUSES: Increased ventilatory drive and decreased
ventilatory capacity
DYSPNEA WITH CVS PATHOLGY:
Ischemic heart Disease
DYSPNEA WITH RESPIRATORY PATHOLOGY:
Asthma
COPD
Emphysema
Infections (pneumonia and T.B.)
Hypoxia
Acidosis/ metablic disorders
Disorder
Acute cause Chronic cause Association
of dyspnea
of dyspnea
with exercise
Asthma
Acute on
chronic
yes
Increased
(exercise
induced)
COPD
No
Yes
Increased
Emphysema
Maybe
Yes
Increased
Lung Infections
Yes
Yes (T.B.)
(pneumonia)
Increased
Hypoxia
Yes
Yes (COPD)
Increased
Acidosis
Yes
Yes
Increased
CHEST PAIN
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Chest pain is a manifestation of a number of serious conditions
and is generally considered a medical emergency.
Associated sign:
– Tenderness on palpation (bone or muscular
pathology)
– Decreased chest expansion (respiratory or
cardiovascular pathology)
CAUSES:
CENTRAL: CVS pathology, e.g, IHD
LATERAL CHEST PAIN:
RESPIRATORY PATHOLOGY e.g.,
• Pneumothorax
• pulmonary embolism
• Pleurisy
• lung cancer
HEMOPTYSIS
• Spitting or coughing up blood or bloody-stained
sputum
Causes:
• T.B.
• Lung carcinoma
• Pneumonia
WEIGHT LOSS
• A reduction in body mass characterized by a
loss of adipose tissue (body fat) and skeletal
muscle
• Associated sign:
– Cachexia
CAUSES:
• T.B.
• Lung carcinoma
• Chronic diseases e.g., COPD, asthma etc
SYNCOPE
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Temporary loss of consciousness due to
generalized cerebral ischemia
Causes:
• Pulmonary embolism
• Emphysema
• Internal bleeding
• High grade fever
• Vasovagal shock
FATIGUE
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FATIGUE IS PHYSICAL AND/OR MENTAL EXHAUSTION THAT CAN
BE TRIGGERED BY STRESS, MEDICATION, OVERWORK, OR
MENTAL AND PHYSICAL ILLNESS OR DISEASE.
CAUSES:
• Infection
• Inflammation
• Trauma
• Malignancy
• Chronic disease e.g., COPD
• Autoimmune diseases
TRACHEAL DEVIATION
Towards the side of lesion:
• Lung collapse (with or without
pneumothorax on opposite side)
• Fibrosis e.g., in bronhiectasis or
cavitation
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Away from the side of lesion:
• Space occupying lesion
• Fluid in the space: plueral effusion or empyema
• Air in the space: pneumothorax
USE OF ACCESSORY MUSCLES OF RESPIRATION
• Scalene muscles
• Sternocleidomastoid
• Trapezius
• Serratius anterior
• Pectoralis major and minor
• Latissimus dorsi
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CAUSES:
1. COPD
2. Decreased vital capacity (Emphysema)
3. Spinal cord injury (cervical)
DECREASED CHEST EXPANSION
CAUSES:
1. Consolidation
2. Lung collapse
3. Fibrosis
4. Cavitation
5. Pleural effusion
6. Empyema
7. Pneumothorax
PERCUSSION NOTE
• DULL:
1. Consolidation
2. Collapse
3. Pleural effusion (stony dull)
• IMPAIRED:
1. Fibrosis
2. Cavitation
3. Bronchopneumonia
• HYPER-RESONANT (presence of air):
1. Pneumothorax
2. Emphysema
VOCAL RESONANCE
 The prolongation and intensification of sound
produced by transmission of its vibrations to a
cavity
 INCREASED:
 Air present in the alveoli/ consolidation/ fibrosis in the
lung parenchyma e.g, Pneumonia, bronhiectasis
 DECREASED:
 Fluid or air present in pleural space e.g, pleural
effusion, pneumothorax
BREATH SOUNDS
INCREASED:
Consolidation
Interstitial lung disease (prolonged expiration)
VESICULAR (PROLONGED EXPIRATION):
Bronchitis
Asthma
Pneumonia
Emphysema
WHEEZING
• Wheezing is a high-pitched whistling sound
during breathing.
• It occurs when air flows through narrowed
breathing tubes
PALPITATIONS and TACHYCARDIA
• TACHYCARDIA: A rapid heart rate, usually defined as
greater than 100 beats per minute.
• PALPITATIONS: A sensation in which a person is aware of
an irregular, hard, or rapid heartbeat.
WEIGHT LOSS
• A reduction in body mass characterized
by a loss of adipose tissue (body fat) and
skeletal muscle
• Associated sign:
– Cachexia
Causes:
• T.B.
• Lung carcinoma
• Chronic diseases e.g., COPD, asthma etc
FATIGUE
Fatigue is physical and/or mental exhaustion that can be triggered
by stress, medication, overwork, or mental and physical illness or
disease.
CAUSES:
• Infection
• Inflammation
• Trauma
• malignancy
• chronic disease e.g., COPD
• autoimmune diseases
CREPITATIONS
A noise produced by pressure upon tissues containing
abnormal amounts of air, the rubbing of fractured ends
of bones, and by cracking joints
CAUSES:
• Consolidation
• Localized fibrosis
• Cavitation
• Pneumothorax
GENERAL PHYSICAL EXAMINATION
VITALS:
Pulse
B.P.
Respiratory Rate
Temperature
HANDS:
Clubbing and Cyanosis
HEAD AND NECK:
Tracheal Deviation
Lymph nodes and Thyroidgland
MOUTH:
Central cyanosis
BACK:
Vertebrae, kyphosis and scoliosis
IMPORTANCE OF GENERAL PHYSICAL
EXAMINATION
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Pursed lips breathing: COPD
Respiratory rate: increased / decreased
Pulse: tachycardia
Cyanosis: central in respiratory failure
Clubbing: emphysema,
JVP: cor pulmonale
Chest deformity: kyphosis, scoliosis
Tracheal deviation: towards or away from side of lesion
Lymphadenopathy: carcinoma, T.B., sarcoidosis
Leg edema: cor pulmonale
Horner’s syndrome: pancoast tumor
PALPATION
4 COMPONENTS:
• Tracheal deviation
• Cervical lymphadenopathy
• Apex beat
• Chest expansion
PERCUSSION
• Done seperately in each space
• Note can be:
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Dull
Stony dull
Resonant
Impaired
Tactile Vocal Fremitus Areas of percussion
AUSCULTATION
Listen in each space for:
• Breath sounds (normal, bronchial, vesicular, loud or
diminshed)
• Wheezes
• Crackles/ crepitations
• Vocal Resonance (dull, stony dull, hyper resonant)
REFERENCES
• Davidson’s Principles and Practice of medicine
• Hutchison’s Clinical Methods
• www.medlineplus.com
• Medlineplus.com
• Britannica online dictionary
• Merriam-Webster dictionary