Respiratory- Common Presenting Symptoms

Question 1

Breathlessness- what is it

Answer 1

• dyspnoea can be caused by psychological, anaemia, respiratory or cardiac disease

Question 2

Mechanism of SOB in respiratory diseases

Answer 2

• stimulation of intrapulmonary afferent nerves by interstitial inflammation or thromboembolism
• mechanical loading of respiratory muscles by airflow obstruction or reduced lung compliance in fibrosis
• hypoxia due to ventilation/perfusion mismatch, stimulating chemoreceptors

Question 3

Questions that may help distinguish the causes of breathlessness- how did it start?

Answer 3

1. how did the breathlessness start?
   - if the onset was instantaneous (think pneumothorax, PE, anaphylaxis)
   - paroxysmal nocturnal dyspnoea may wake a sleeping patient with SOB
   - onset over hours is typical in asthma, acute pulmonary oedema, lobar pneumonia or hypersensitivity pneumonitis
   - insidious onset can occur in COPD, ILD, pleural effusion and lung tumours

Question 4

Questions that may help distinguish the causes of breathlessness- how is breathing at night or at rest

Answer 4

• asthma commonly wakes patients, whereas COPD are comfortable at rest but worsen on exertion
• breathlessness when lying down (orthopnoea) is a Sx of HF
• Orthopnoea occurs with severe airflow obstruction or diaphragmatic weakness because the weight of the abdomen displaces the diaphragm

Question 5

Questions that may help distinguish the causes of breathlessness- does breathlessness vary day-day or week-week

Answer 5

• variable breathlessness is typical of asthma whereas patients with COPD or ILD usually report consistent daily limitation

Question 6

Questions that may help distinguish the causes of breathlessness- can you tell me something that would make you breathless

Answer 6

• these reveal the disability caused by respiratory disease
• record restriction on normal activity or work
• enquiring about hobbies and daily activities

Question 7

Questions that may help distinguish the causes of breathlessness- when does breathlessness start

Answer 7

• asthma induced by exercise frequently appears only after exercise during early recovery because of sympathetic drive during exercise defends airway patency

Question 8

All the questions for breathlessness

Answer 8

1. how did it start
2. how is your breathing at rest and overnight
3. Does your breathlessness vary day-day or week-week
4. Can you tell me something you do that would make you breathless
5. When does the breathlessness start

Question 9

Diagnostic approach

Answer 9