Переводчик Арендт Дарья

Respiratory system
Symptoms Cough and sputum A cough is one of the most common presentations of respiratory pathology. The timing, onset, precipitating factors and progression of a cough should be noted along with the amount and appearance of sputum produced. The most common patterns are shown in Table 3.1. Haemoptysis (coughing up of blood from the lungs) may be caused by a number of conditions. It is usually streaky, rusty coloured and mixed with sputum. It should be distinguished from haematemesis (vomiting of blood) which may appear bright red or like coffee grounds.
1 The most common cause is acute infection, particularly with underlying chronic obstructive airways disease.
2 Other important causes are bronchial carcinoma and tuberculosis – these should be looked for, unless in a young, non-smoking patient with an acute infection.
3 Pulmonary oedema in cardiac failure causes pink, frothy sputum and pulmonary infarction such as pulmonary embolism may cause haemoptysis.
4 Other less common causes include Goodpasture’s syndrome, vasculitis such as microscopic polyarteritis, cystic fibrosis and clotting abnormalities. Massive haemoptysis may be caused by bronchiectasis, bronchial carcinoma or tuberculosis.
Dyspnoea Dyspnoea is an unpleasant sensation of difficulty in breathing. Patients may complain of breathlessness, difficulty in ‘catching their breath’, a feeling of suffocation, or tightness in the chest. Dyspnoea should be graded by the exertional capability of the patient and the impact on their lifestyle. It is useful to document when breathlessness occurs, e.g. after 200 yards on the flat, up 1 flight of stairs. In general dyspnoea arises from either the respiratory or cardiovascular system and it is often difficult to distinguish between them. Although the presence of orthopnoea and paroxysmal nocturnal dyspnoea suggests a cardiovascular cause, patients with lung disease may experience orthopnoea due to abdominal contents restricting the movement of the diaphragm. For diagnosis, respiratory dyspnoea is best considered according to the speed of onset and further differentiated by a detailed history and clinical examination