respiratory disease investigation

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Investigations Respiratory System

Vd. Santhosh B


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Objective

To highlight some of the important

basic investigations pertaining to

diseases of respiratory system


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Introduction

One third of the deaths in world

caused by respiratory diseases

Emergency management needed

Diagnosis Prognosis


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Principal Symptoms

1. Cough

2. Sputum production

3. Haemoptysis

4. Chest pain

5. Breathlessness

6. Wheeze


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Sound

Feeble non-explosive : respiratory muscle weakness

: lung cancer

Prolonged wheezy : severe airflow obstruction

(Asthma or COPD)

Harsh barking : laryngeal infection

Moist : bronchiectasis

Dry : tracheitis and pneumonia


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Circumstance

Nocturnal Asthma

During and after swallowing liquids

neuromuscular disease of oropharynx


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Amount

Large volume of purulent sputum

bronchiectasis

Sudden large purulent rupture of lung

abscess

Large watery sputum with pink tinge

pulmonary oedema


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Colour

Clear/mucoid COPD without active infection

Yellowish acute LRTI (live neutrophils)

Green chronic infection (dead neutrophils)

Rusty red pneumo-coccal pneumonia


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Amount and Appearance

Streaking of clear sputum with blood or the

presence ofblood clots in the sputum for

more than a week is suggestive of lung cancer

Haemoptysis with purulent sputum suggests

an infective cause such as bronchiectasis


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Pleural Pain

It is sharp, stabbing and always intensified by

inspiration or coughing


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Chest Wall Pain

Indicate respiratory or musculoskeletal

disease

Patients with COPD or asthma usually develop

this pain


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Mediastinal Pain

Typically central, retrosternal and unrelated to

respiration or cough


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Variability

Left ventricular failure and respiratory muscle

weakness commonly present with breathlessness

when lying flat

COPD waking in the morning (3am 5am) due to

breathlessness

Breathlessness that improves at the weekend or on

a holiday is suggestive of occupational asthma


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Nature

Wheeze on exercise is a common symptom of

asthma and COPD

Wheezing that cause night wakening

Asthma

Wheeze after wakening in the morning

COPD


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General examination

Inspection (abnormalities in shape of chest)

Palpation (chest expansion)

Percussion (resonant note)

Auscultation (normal breath sounds)


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Percussion Note

Resonant - Normal

Hyperresonant - Pneumothorax

Dull - Pulmonary consolidation

Pulmonary collapse

Pulmonary fibrosis

Stony dull - Pleural effusionHaemothorax


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Chest X-ray

Lung fields (equal translucency)

Lung apices (look for masses, cavitation)

Heart (normal shape)

Diaphragm (hyperinflation)


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Sputum Examination

Patients with unexplained haemoptysis or

suspected lung cancer, sputum is sent for

CYTOLOGICAL EXAMINATION

In LRTI symptoms microbiological culture

Pneumonia Gram stain is used

Gram positive pneumococcus or staphylaococcus

Gram negative Haemophilus influenza


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Oximetry

Spectrophotometric device

Measures arterial oxygen saturation (SaO2)

Helps in oxygen therapy

SaO2


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Arterial blood gas analysis

PaO2 , PaCO2 and pH

Respiratory Acidosis ( PaCO2 pH)

Respiratory Alkalosis ( PaCO2 pH)


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Spirometry

Forced expiratory volume in one second

Forced vital capacity

Ratio > 75% (Adult)

If it is < 75%, it indicates air way obstruction


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Summary

Disease condition can be predicted by the

symptoms only

It can be solidified by the investigations


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Conclusion

Oxygen is the foremost thing required for life

Alarm of the respiratory disease is given by

the symptoms

Investigations confirm them and help in

treatment and restoring the life


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Further clarification

Macleods Clinical Examination: 11th

edition: pp 124-147


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respiratory disease investigation

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