Symptoms of abnormality of the respiratory system

My two-cents Rx

With Benj S. Bangahan, M.D., FPCP, FPCCP

It is probably of benefit to the laymen if they are made familiar with the different symptoms or feelings emanating from the respiratory system that they, their family members and friends, may experience at any given time, and what to correlate them with. The awareness might make them act more quickly and save their lives or those of their loved ones.  Some diseases of the lung or the airway, as well as those of the adjacent anatomical parts, may turn out to be morbid, but somehow doctors are able to obviate the morbidity when they recognize a disease in advance and do the appropriate management.

Cough, most especially when persistent for a rather long time, should be considered worth worrying about. The cough reflex that is bringing about the body defense mechanism may be one located in the upper part of the respiratory tree (windpipe) or in any portion of the airway, or in the covering of the lungs that are as the pleura.  The cough might even be a response from the ones located in the nearby adjacent parts like the sinuses, the covering of the heart which is called pericardium, the auditory canal part of the ears, or from the esophagus (the gullet),  the stomach and the diaphragm. Long standing cough that persists despite some treatment is usually associated with the habit of smoking, and it becomes worse and bothering when it has gone far to the stage called by doctors as chronic obstructive pulmonary disease (COPD). It may also be caused by asthma that is actually active mildly, but left disregarded by the patient. There are cases of cough that can be confusing to patients since these people are quite convinced that they do not have any direct respiratory condition that can explain the symptom.  It is because they are not aware that a non-respiratory condition like a simple inflammation of the sinus that develops postnasal drip can cause coughing, just as reflux of acidic fluid from the stomach to the esophagus can also make people cough. There are medications taken by patients for other diseases that are potential causes of cough that only doctors may be able to suspect; sometimes allergens, or substances that can induce respiratory allergy may be the culprit.

 Some patients complain of a crowing sound in the process of breathing. It is called stridor,  and it is developed when something causes a narrowing of the airway; the passage of the air during respiration through the small airway is what leads to crowing.  The cause of the narrowing may be external or internal to the airway, but because of the prevailing obstructive phenomenon, the cause must be  immediately managed.

Wheezing sounds may be quite familiar to many people because the cause is common –- asthma.  The sound is described as continuous musical or whistling noise, produced by the airflow as it passes through the narrowed small airway consequent to the asthmatic episode. Asthmatic attack when adequately treated usually responds quickly, but there have been cases when, due to the extreme constriction that has occurred, it can be lethal.

Perhaps the two most dreadful symptoms that can be complained of by patients are dyspnea and hemoptysis. Dyspnea is that feeling of having severe difficulty of breathing during whatever activity. While there are abnormalities of non-respiratory organs that may explain the cause of dyspnea, the difficulty of breathing that is respiratory in origin usually is attributable to the abnormality of the air passage, the lung parenchyma itself,  the covering of the lung or pleura, the muscles of respiration and the chest wall. Dyspnea may be classified according the circumstances. It may be paroxysmal nocturnal dyspnea, which is the difficulty of breathing at night, or orthopnea, which is dyspnea when lying down.  Both of them have been associated with inadequate function of the left side of the heart, but are also seen in asthma and in chronic obstructive pulmonary disease due to smoking.

Platypnea is the difficulty of breathing when in upright position and becomes relieved when patient lies down; a rare condition in which blood is shunted from the right to the left side causes this condition.

Hemoptysis is the coughing up of some amount of blood that is adhering to the sputum.  In a massive case, the amount may be as big as 200 to 600 milliliters in 24 hours. It is usually considered as a sign of a severe disease of the bronchial tree and or the lung parenchyma, and infection of the bronchus, bronchiectasis, tuberculosis and cancer  are the common causes. It is advised that hemoptysis be differentiated from hematemesis, the vomiting of blood, by being sure that the blood is coughed up, and therefore hemoptysis, and not vomited, which is hematemesis.  In addition to that, coughed up blood is usually bright red while vomited blood is dark, as a result of the action of the acid from the stomach.

Māassalāma.

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