Clinical manifestations of respiratory diseases

The core clinical manifestations of respiratory diseases can be divided into three categories: local airway reaction, systemic inflammatory reaction, and secondary organ involvement. Different causes and differences in individual basic conditions will lead to a huge range of manifestations. It is easy to miss diagnosis and misdiagnosis based only on "cough and fever".

Just talking about the most familiar local symptoms, upper respiratory tract reactions such as nasal congestion, runny nose, and sore throat, they may seem ordinary but there are actually many ways to deal with them. For the same sore throat, type A streptococcus infection attacks at an alarming speed. It can develop to the point where swallowing saliva feels like swallowing glass shards in half a day, and is often accompanied by tonsil suppuration. ； The sore throat caused by the new coronavirus infection is more of a burning sensation, and the throat feels as dry as a fire for several days in a row. ； The pain of allergic pharyngitis is mostly mild, appearing together with paroxysmal dry cough, and worsening when exposed to cold air or oil smoke. Regarding the treatment of this type of sore throat, there is currently no unified conclusion in the academic community: European and American diagnosis and treatment guidelines generally require that a rapid streptococcal antigen test be performed first, and antibiotics will be used only if the test is positive. Many domestic grassroots doctors consider that streptococcal infection may induce complications such as rheumatic fever and glomerulonephritis, and will directly prescribe antibiotics to patients with obvious suppuration. Each logic has its own considerations, and there is no absolute right or wrong.

In addition to these upper respiratory tract symptoms that can be recognized at a glance, abnormal signals in the lower respiratory tract are often easier to ignore. I met a 42-year-old smoker at the outpatient clinic last week. He is used to coughing occasionally. This time, he coughed up yellow purulent sputum for a week, occasionally with some blood streaks. He took cough syrup for half a month, but it didn't feel better. When he came for a CT scan, he discovered that it was bronchiectasis combined with infection. There are also many asthma patients who don’t cough at all when they have an attack. Instead, their chests feel as tight as a piece of wet cotton. They have to stop and gasp after taking two steps. Many people first go to the cardiology department for a check-up, and then go back to the respiratory department.

What is even more alarming is that the first manifestation of many respiratory diseases does not occur in the respiratory tract at all. At the peak of influenza at the end of last year, a 16-year-old high school student came here with the help of his parents. He said that his fever had reached 39.5°C for three consecutive days. His muscles ached all over his body and he could not even get out of bed. He had neither a cough nor a stuffy nose and sore throat. At first, he thought it was influenza. After taking oseltamivir for three days, it was useless. After a CT scan, it was found that there was a large mycoplasma pneumonia lesion in the lower lobe of the right lung. There are also differences in clinical treatment ideas for such atypical cases: one group of doctors believes that as long as the patient has high fever for more than 3 days, CT should be routinely taken to check for pneumonia regardless of whether there are respiratory symptoms. The other group believes that as long as the patient's blood oxygen saturation is normal and the mental state is acceptable, blood routine and etiology testing should be given priority, and there is no need to perform routine CT to avoid unnecessary radiation exposure. Both views are from the perspective of patient benefit, but the focus of the trade-off is different.

If the infection is not well controlled and pathogens or toxins enter the blood, organs other than the respiratory tract may be affected. A 72-year-old man with chronic obstructive pulmonary disease was admitted to the hospital the year before last. After getting COVID-19, he first had a fever and cough. Two days later, he started to have chest tightness, palpitation, and lower limb edema. Myocardial enzymes and BNP were both high when tested. He had combined viral myocarditis and heart failure. There are also many children who first develop gastrointestinal symptoms of nausea, vomiting, and diarrhea after contracting respiratory syncytial virus pneumonia. Many parents initially treat the disease as gastroenteritis, which delays the best time for intervention.

I have been working in the respiratory department for almost 11 years, and I have seen the most diverse manifestations of respiratory diseases: some had gum pain and were eventually diagnosed as influenza, some had chest tightness every early morning and were eventually diagnosed as cough variant asthma, and some even just felt tired and did not want to eat, but were found to be severe pneumonia. Especially for the elderly and people with low immunity, the immune response is weak. Typical symptoms such as fever and cough may not appear at all. They will only appear as poor energy, loss of appetite, and lethargy. If family members are careless, it can easily become severe.

Don’t think that respiratory diseases are all caused by infections. Non-infectious diseases such as pneumoconiosis, allergic rhinitis, and chronic obstructive pulmonary disease have their own characteristics. Pneumoconiosis patients cough up gray-white sputum all year round, which gets worse in winter. ； Patients with allergic rhinitis often sneeze and have runny nose in spring and autumn, which can be relieved half a day after removing the allergen. There was a patient who took cold medicine for almost a week, only to find out later that he was allergic to the hair of a new Persian cat he bought at home. After two days of glucocorticoid spray, he was completely cured.

After all, there is no standard answer to the manifestations of respiratory diseases. The same pathogen may manifest differently in different people. If you really feel uncomfortable, don't force yourself to do it, and don't use the online symptom comparison chart to diagnose yourself. It's better to find a professional doctor to make a comprehensive judgment based on medical history and examination.