Most of the respiratory diseases are diagnosed by asking the patient or by examining their sputum or chest X-ray. But many diseases and blood tests also have to be done.
When the patient comes, he should be asked in detail about his problem like since when he has been coughing, at what time does it occur more, whether there is phlegm or not. What is its colour, whether he feels breathless or not. Whether there is difficulty in breathing or not. Whether there is pain in the chest or not. Whether there is any sound while inhaling or exhaling, what work does the patient do, whether he takes any medicine or intoxicant or not etc.
Physical examination
> While examining the chest, if possible, remove the upper clothes. > Whether the chest expands completely while breathing or not.
> Whether any lymph gland is enlarged or not. What is the shape of the chest. > While examining the throat, see whether the tonsils are enlarged or not.
> Whether the place of trachea is fine or not.
> Percussion Note- Is it equal on both sides or not.
Auscultation
• Is the breath coming equally on both sides of the chest or not.
• What is the sound of the breath? Is there any wheezing or other sound with it?
Special Investigations
- X-ray chest
- Sputum is helpful in diagnosis of following diseases
- Tuberculosis.
- Bronchial Carcinoma
- Blood tests (Investigation) TLC, DLC, ESR.
- Pleural Fluid, T.B., Malignancy.
- Skin tests (Skin Tests)
- Laryngoscopy
- Bronchoscopy
- Biopsy
- Pulmonary Function Tests
- Analysis of arterial blood gases.
Chest Pain
Usually four types of pain are observed in respiratory diseases:- (1) Stinging and pulling pain in the middle of the chest below the sternum which increases with coughing. Mostly occurs in tracheitis.
(2) A strange discomfort and heaviness is felt in the middle of the chest which is related to mediastinal tumors. (3) Pain in one side of the chest which mostly occurs in the armpit (below the shoulder) or sometimes in the back. This pain seems to be very sharp and chronic which increases with deep breathing or coughing. Its main causes are fracture of the chest bone or pleurisy.
(4) Persistent chest pain in which there is no difference whether you breathe or not, due to which the nerve roots of the chest get compressed or there is a change in them. Chest cancer or cancer from other parts of the body spreads to the chest, which causes persistent chest pain.
(i) Pleural pain is caused by the stretching of the outer pleura when the chest expands, due to which the patient is unable to take long breaths freely.
(ii) Pain in the front and upper part of the shoulder indicates diaphragm pleurisy.
Shortness of breath (Dyspnoea)
Breathing is a natural process which happens in humans without any difficulty, but when a person experiences difficulty in breathing and becomes aware of it, then that condition is called 'Dyspnoea'.
Causes:
• Asthma
• Chronic bronchitis
• Anaemia
• Fibrosing Alveolitis
• Some heart diseases
Wheeze - This is a type of wheezing or rattling sound that can be heard on the chest with a stethoscope while exhaling. It is especially found in asthma.
Stridor - This is heard while breathing. Its cause is any type of obstruction in the larynx, trachea or main bronchus.
Hypoxaemia - It occurs due to the pressure or lack of oxygen in the blood. 'Central cyanosis' can be seen due to excessive 'hypoxaemia'. The formation of such places in the lungs where the balance between the supply of fresh air and distribution of oxygen is disturbed is the main reason for this. This leads to increased ventilation.
Other reasons:
• High altitude such as mountainous areas.
• Excessive exercise and toxicity of carbon mono oxide.
• Anaemia
All these reasons are cured by giving oxygen.
Hypercapnia
This is caused by an increase in the amount of carbon dioxide (CO2) in the blood. Symptoms are - the patient feels heat in the hands and feet, sweating, headache, restlessness and dizziness.
Sputum
Curd yellow to green colour such as:
• Acute bronchitis
• Chronic bronchitis
• Bacterial pneumonia
• Bronchiectasis
• Lung abscess
Foamy - (due to excess bronchial mucus)
• Chronic bronchitis
• Bronchial asthma
• Early stage of tuberculosis
Haemoptysis
• Acute and chronic bronchitis • From lower respiratory tract
• Pulmonary infarction
• Tuberculosis
• Bronchiectasis
