Symptoms in the Pharmacy :Respiratory Problems (last)

Respiratory symptoms for direct referral

Chest pain

Respiratory causes
A knife-like pain is characteristic of pleurisy. It is a localised pain
which is aggravated by taking a breath or coughing. It is usually
caused by a respiratory infection and may be associated with an
underlying pneumonia.

Less commonly it may be caused by a pulmonary
embolus (a blood clot which has lodged in a pulmonary artery
after separating from a clot elsewhere in the circulation).
A similar pain to that experienced with pleurisy may arise from
straining the muscles between the ribs following coughing. It may
also occur with cracked or fractured ribs following injury or
violent coughing. Another less common cause of pain is due to a
pneumothorax where a small leak develops in the lung causing its
collapse.
The upper front part of the chest may be very sore in the early stages
of acute viral infections that cause inflammation of the trachea (tracheitis).
Viral flu-like infections can be associated with non-specific
muscular pain (myalgia).

Non-respiratory causes

Heartburn
Heartburn occurs when the acid contents of the stomach leak backwards
into the oesophagus (gullet). The pain is described as a burning
sensation, which spreads upwards towards the throat. Occasionally it
can be so severe as to mimic cardiac pain.

Cardiac pain
Cardiac pain typically presents as a tight, gripping, vicelike,
dull pain that is felt centrally across the front of the chest. The pain
may seem to move down one or both arms. Sometimes the pain
spreads to the neck. When angina is present, the pain is brought
on by exercise and relieved by rest. When a coronary event such as a
heart attack (myocardial infarction (MI)) occurs the pain is similar but
more severe and prolonged. It may come on at rest.

Anxiety
Anxiety is a commonly seen cause of chest pain in general practice.
The pain probably arises as a result of hyperventilation. Diagnosis can
be difficult as the hyperventilation may not be obvious.

Shortness of breath

Shortness of breath may be a symptom of a cardiac or respiratory
disorder. Differential diagnosis can be difficult. It is usually a sign of a
serious condition although it can be due to anxiety.

Respiratory causes

Asthma
Occasionally asthma may develop in later life, but it is most
commonly seen in young children or young adults. The breathlessness
is typically associated with a wheeze, although in mild cases the only
symptom may be a recurrent nocturnal cough. Most asthmatics have
normal breathing between attacks. The attacks are often precipitated
by viral infections such as colds. Some are worsened in the hay fever
season, others by animal fur or dust. The breathlessness is often worse
at night.

Chronic bronchitis and emphysema
Chronic bronchitis and emphysema are usually caused by cigarette
smoking and give rise to permanent breathlessness, especially on
exertion, with a productive cough. The breathing worsens when
an infective episode develops. At such times there is also an increase
in coloured sputum production.

Cardiac causes

Heart failure
Heart failure may develop gradually or present acutely as an
emergency (usually in the middle of the night). The former (congestive
cardiac failure) may cause breathlessness on exertion. It is often associated
with ankle swelling (oedema) and is most common in the
elderly. The more sudden type is called acute left ventricular failure
(LVF). The victim is woken by severe breathlessness and has to sit
upright. There is often a cough present with clear frothy sputum.

Other causes

Hyperventilation syndrome
Hyperventilation syndrome occurs when the rate of breathing is
too high for the bodily requirements. Paradoxically the subjective 

experience is that of breathlessness. The sufferer complains of difficulty
in taking in a deep breath. The experience is frightening but
harmless. It may be associated with other symptoms such as tingling in
the hands and feet, numbness around the mouth, dizziness and various
muscular aches. It may be caused by anxiety.

Wheezing

Wheezing sounds may be heard in the throat region in URTIs and are
of little consequence. They are to be differentiated from wheezing
emanating from the lungs. In this latter situation there is usually
some difficulty in breathing.

Wheezy bronchitis
Wheezing occurs in infants with wheezy bronchitis. It is caused by a
viral infection and is completely different from chronic bronchitis seen
in adults. The infection is self-limiting but requires accurate diagnosis.
Children who have a history of recurrent wheezy bronchitis are more
likely to develop asthma.

Asthma
Wheezing is a common feature of asthma and accompanies the shortness
of breath. However, in very mild asthma it is not obvious and may
present with just a cough. At the other extreme an asthma attack can
be so severe that so little air moves in and out of the lungs there is no
audible wheeze.

Cardiac
Wheezing may be a symptom associated with shortness of breath in
heart failure.

Sputum

Sputum may be described as thick or thin and clear or coloured. It is a
substance coughed up from the lungs and is not to be confused with
saliva or nasal secretions.

Bronchitis
Clear thick sputum may be coughed up in chronic bronchitis or
by regular cigarette smokers. It has a mucoid nature and may be
described as white, grey or clear with black particles. Chronic bronchitics
are prone to recurrent infective exacerbations during which
sputum production increases and turns yellow or green.

Pneumonia
Coloured mucoid sputum may be present in other lung infections such
as pneumonia. Rust-coloured sputum is characteristic of pneumococcal
(lobar) pneumonia.

Cardiac
Clear thin (serous) sputum may be a feature of heart failure (LVF). The
sputum forms as a result of pulmonary oedema, which characteristically
awakens the patient in the night with shortness of breath.

Haemoptysis
The presence of blood in sputum is always alarming. It often results
from a broken capillary caused by coughing and is harmless. However,
it can be a symptom of serious disease such as lung cancer or pulmonary
TB and should always be referred for further investigation.
Occasionally blood is coughed up after a nosebleed and is of no
consequence.