Clinical 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.
· The most common cause is acute infection, particularly with underlying
chronic obstructive airways disease.
· Other important causes are bronchial carcinoma and tuberculosis – these
should be looked for, unless in a young, non-smoking patient with an acute
infection.
· Pulmonary oedema in cardiac failure causes pink, frothy sputum and
pulmonary infarction such as pulmonary embolism may cause haemoptysis.
· 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.
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