Patients with diseases of the respiratory system

As in other branches of medicine, a careful and detailed history and physical examination are the cornerstones of an accurate diagnosis in patients with disorders of the respiratory system. In addition, the roentgenographic examination occupies a particularly important role in the evaluation of patients with lung disease. Since abnormalities of the respiratory system are frequently a manifestation of a systemic process, attention must be focused not only on the chest; a comprehensive evaluation of the patient's entire health status is essential.

The history must contain a detailed occupational and personal history with a description of exposure to hazards such as coal, silica, asbestos and so on.

The family history should consider pulmonary diseases which may be on a genetic basis.

Dyspnea is a cardinal manifestation of diseases involving the respiratory and cardiovascular systems. A detailed physical examination of both organ systems is therefore mandatory to every patient with symptom. Dyspnea secondary to cardiac disease is often recognized by the presence of other evidence of 'heart failure, of cardiac enlargement and cardiac murmurs.

Patients with diseases involving the respiratory system may also present with chest pain which is frequently caused by inflammation of the pleura, occurring in pneumonia, tuberculosis and malignancy. Pleuritic pain is usually localized to one side of the chest and is related to movements of the thorax and to respiration. Lesions confined to the pulmonary parenchyma do not produce pain, while diseases involving the organs in the mediastinum may cause local discomfort with radiation characteristic of the specific organ.

Ex.5. Assessment of the respiratory system begins with a thorough patient history. Ask the patient to describe his respiratory problem.

Ex.6. Read the texts. Find out and put down the expressions describing throat and voice pathology. Make up your own sentences using these expressions.

The outstanding symptom of acute pharyngitis, regardless of cause, is a sore throat. About two-thirds of all acute illnesses in families are viral infections of the upper respiratory tract, with varying degree of pharyngeal discomfort present. The acute pharyngitis can be classified into three groups: (1) treatable infections, (2) untreatable infections, and (3) noninfectious disorders.

Physical examination of the pharynx mucosa may reveal changes varying in intensity from mild redness and congestion of blood vessels (many viral infections) to intense red-purple color, patchy yellow exudate, hypertrophy of all the lymphoid tissue, and marked vascular injection. Symptoms may be variable, and may range from a complaint of “scratchy throat” to pain so severe that swallowing of saliva is difficult. The presence of exudate does not establish a specific etiology any may be noted in infections.

Ulceration involving the posterior pharyngeal wall and/or tonsils are characteristically present in fungobacterial infections, tuberculosis, following local trauma to the pharynx.

The tonsils are often involved in the course of viral and bacterial pharyngitis; they may be markedly reddened and swollen.

The etiologic diagnosis of acute pharyngitis is difficult to establish on the basis of visual examinations of the throat.

Symptoms: Change in tone or quality of voice to a coarse, harsher sound, need to clear the throat; sometimes fever, swallowing difficulty and throat pain or discomfort, depending on cause.

Cause: The voice box (larynx) becomes inflamed as a r4esult of inhaling smoke, chemical fames, gases, vapors or dust, overuse or abuse of voice; excessive use of alcohol; diseases such as sinusitis, tonsillitis, bronchitis, flu, the common cold, pneumonia and pharyngitis, polyps in the throat, cancer and others.

Treatment: Depends on basis for problem. However, initial treatment usually includes “not talking” in order to rest the larynx, no smoking or drinking; an increase in fluids and medication if seemed necessary. Further treatment would depend on the cause of the hoarseness.

Symptoms: Cough that is initially hacking and dry. Then gradually becomes loose, with production of mucus or yellow sputum. There may be fever (if infection is present), generalized malaise and fatigue, sensation of tickling or tightness in chest and sensation or sound of rafting in the chest. If the bronchitis follows a cold, there may also be congestion of the nose and postnasal dry. Coughing is often worse in the morning than at night.

Cause: Acute Bronchitis may result from infection as a complication of a cold (upper respiratory infection) or as a result of irritation of a lining of the air passages by inhaling substances such as smoke, pollen, dust, fumes or fibers.

Severity of problem: Usually of mild to moderate severity and resolves with treatment. If cause is not corrected, it may become chronic.

Treatment: Depends on cause but involves removing or avoiding any irritants (stopping smoking, avoiding dust), drinking much fluid and resting. Moisture in the air (involving steam) is sometimes soothing. If the cough is dry and irritating, or interferes with sleep, medication to suppress it might be recommended. Antibiotics may be prescribed by the doctor if bacterial infection is suspected or known.

Discussion: Mild, acute Bronchitis is almost always present temporarily with upper respiratory infection (common cold) and does not require antibiotic treatment unless high fever occurs, or sputum becomes yellow or greenish rather than white or clear.

Chronic Bronchitis is a real problem in adults, problem thought to be “Chronic Bronchitis” in infants and children are more likely to be asthma or other illness. Bronchitis where there is a lot of wheezing can be suspected of being asthma. People with moderate to severe chronic Bronchitis should probably receive influenza vaccines (‘flu shots’).

Ex.8. Read the text. State the main ideas of it in a written form. Retell the text according to this plan.

Bronchial asthma usually starts in childhood but may not appear until middle age (“late-onset asthma”). It is characterized by attacks of wheezing dyspnoea due to narrowing of bronchial tube by spasm, mucosal edema or mucous secretions. These attacks are brought on by a variety of factors, including allergy to certain inhaled dusts (e.g. house dust, pollens), respiratory infections, emotional upsets or physical exertion (“exercise – induced asthma”). A history of other “allergic” manifestations such as hay fever or a family history of this condition, is common in those with an early onset of the disease. The patient may be quite free of symptoms and abnormal signs between the attacks but the illness can become continuous. Cough usually occurs only during the attacks when it may be associated with the expectoration of vicid mucoid sputum; noctural cough is a characteristic presenting symptom of asthma in childhood.

Physical examination reveals labored breathing associated with a prolonged expiratory wheeze, activity of accessory muscles of respiration, signs of overinflation of the lung due to trapping of air during expiration and, in a severe attack, cyanosis may also be seen. In children, there may be permanent deformity of the chest wall.

Bronchial asthma must be differentiated from the paroxysmal dyspnoea of left heart failure and from localized wheezing due to partial bronchial obstruction by neoplasm.

Ex.9. Read the text, write down the key sentences of it using the following models:

Symptoms: Sudden, intense stabbing pain in the side or shoulder, aggravated by deep breathing, coughing, sneezing or moving. Breathing is usually rapid and not very deep.

Cause: May result from injury or irritation of the underlying lung; entry the irritating substance into the pleural space; entry of infection either from the lung or through the bloodstream; or leakage of tumor cells into the pleural space.

Treatment: depends on treating underlying cause. Heat applied to chest and pain relieves help with symptoms. Antibiotics are used if infection suspected or proved.

Discussion: Inflammation of the pleura, the membranes lining the chest and covering the lungs, causes pain when the lung moves back and forth over the inflamed area. Sometimes infection is irritating enough that fluid gathers in the chest between the ribs and lung (called pleural effusion). This kind of fluid collection, if present can be drained by needle or tube and the fluid studied for infection and abnormal (cancer) cells. Depending on cause, pleurisy can occur one time only or be a recurrent problem.

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