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The clinical presentation of respiratory disease 

The clinical presentation of respiratory disease

The clinical presentation of respiratory disease

Julian Hopkin


May 30, 2013: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 29 April 2017

Respiratory disease can present in many ways, with variations attributable to many factors. The clinical presentation directs diagnostic hypothesis making, the choice of diagnostically discriminating investigations, and the most appropriate management. If a detailed history is not taken, the patient not observed carefully and examined diligently, and the information from these sources is not analysed correctly, then inappropriate investigation and management is likely.

History—common symptoms of respiratory disease are breathlessness, cough, haemoptysis, and pleuritic chest pain, details of which can point to particular diagnoses. An account of environmental exposures at work and home, and of family history, is critically important in some cases.

Clinical examination—this begins with assessment of general features: physical findings outside the chest can be vital in diagnosis. Accurate monitoring and documentation of respiratory rate, pulse rate, and temperature are essential in the acute setting. Immediate pointers to respiratory disorder are repeated cough, wheeze or stridor, painful breathing, laboured or ineffective breathing, or cyanosis, but it is crucial to remember that respiratory failure can present as a torpid or drowsy state without clear respiratory distress. Observation of the chest, followed by palpation, percussion, and auscultation must be performed systematically, and the physician who practices these skills regularly will be better at them than the one who does not. In chronic respiratory disease, where breathlessness and disability are to be assessed, walking with the patient and observing exercise tolerance and distress (and pulse oximetry) can provide valuable information.

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