Chapter 28: Common Respiratory Complaints

Common Respiratory Complaints systematically addresses three prevalent respiratory complaints that drive patients to seek medical evaluation: cough, dyspnea, and hemoptysis. Cough, the most common reason Americans seek healthcare, is classified by duration into acute presentations lasting less than three weeks, subacute cases extending three to eight weeks, and chronic coughs persisting beyond eight weeks. The underlying mechanisms vary widely and include altered airway secretions from conditions like chronic obstructive pulmonary disease and postnasal drainage, hyperreactive airways associated with asthma, infectious processes such as pneumonia and tuberculosis, progressive diseases including malignancies and interstitial lung disease, and gastroesophageal reflux disease. Certain medications, particularly angiotensin-converting enzyme inhibitors, induce coughing in approximately ten percent of users through their effects on the bradykinin cascade. Clinical evaluation relies heavily on thorough history taking, which establishes the diagnosis approximately eighty percent of the time, supplemented by physical examination findings such as cobblestoning in the oropharynx and adventitious lung sounds. Management prioritizes treating the underlying etiology rather than merely suppressing symptoms, though antitussive agents and expectorants provide temporary symptomatic relief. Dyspnea, the subjective sensation of breathlessness, represents the third most frequent primary care complaint and stems predominantly from respiratory conditions in seventy-five percent of cases, with cardiac etiologies accounting for most remaining presentations. Clinical assessment employs quantification scales and functional capacity evaluation to guide treatment decisions. The diagnostic workup includes imaging, laboratory studies, and pulmonary function testing to differentiate between respiratory and cardiac causes. Hemoptysis, defined as blood expectoration from the lower respiratory tract, results from inflammatory processes in approximately eighty percent of cases, with age-related patterns influencing diagnostic considerations. Differentiation from hematemesis and epistaxis is essential, and management varies considerably between life-threatening massive hemoptysis requiring emergency intervention and chronic presentations managed through causative treatment and patient education regarding smoking cessation and symptom monitoring.