Localising breathlessness

• pleural diseases = increased inspiratory and an increased expiratory effort
• LRT restrictive disease = fast shallow breaths
• URT disease = slow respiratory rate with an increase in inspiratory effort
• Tachypnoea = Increased respiratory rate
• Hyperpnoea = Increased respiratory effort
• Orthopnoea = Dyspnoea in any position other than standing or erect sitting – usually due to bilateral pulmonary oedema
• Trepopnoea = dyspnoea in one lateral recumbency but not the other – unilateral lung or pleural disease, or unilateral airway obstruction e.g unilateral pleural effusion
• wheezes = high pitched
• rhonchi = low pitched
• wheezes and rhonchi are commonly expiration noises
• wheezes and rhonchi are often due to the narrowing of airways
• crackles = rales which can be dry of moist

  • moist = CHF and is most prominent on inspiration
  • dry = acute or chronic
• with a pleural effusion the tympanic sounds created by the chest wall during percussion are dull below the fluid line but normal above it
• what makes up the respiratory portion of the resp tract?

  bronchioles, alveolar ducts, alveolar sacs and the alveoli
• what makes up the air conducting portion of the resp tract?

  the nasal cavities, nasopharynx, larynx, trachea, bronchi and bronchioles
• the respiratory portion of the resp tract has simple squamous epithelium with scant loose connective tissue
• Respiratory epithelium = ciliated, pseudostratified columnar epithelium
• the bronchi have the muscularis, a layer of smooth muscle which the trachea does not have
• More distally, the respiratory epithelium becomes simple columnar or simple cuboidal (still ciliated!)
• alveoli epithelium = simple squamous
• bronchiole epithelium = simple cuboidal
• Alveolar ducts = Elongated airways that are lined by alveoli only
• Alveolar sacs = Spaces surrounded by clusters of alveoli
• Type 1 alveolar cell (type 1 pneumocyte) = Very thin squamous cell, line 95% of the alveolar surface
• Type 2 alveolar cell (type 2 pneumocyte)= Cuboidal cell, secretes surfactant, covers ~ 5% of the alveolar surface
• URT disease is characterised by inspiratory difficulty and audible noise
• Pleural space disease may have characteristic respiratory pattern and possible muffled heart and lung sounds
• dyspnoea = difficult or laboured breathing
• what pattern is present in this case?

  interstitial

  
• what pattern can be seen below?

  interstitial