Main symptoms of respiratory illness

The core common symptoms of respiratory diseases are concentrated in five categories: cough, sputum production, chest tightness and shortness of breath, throat/chest pain, and abnormal respiratory secretions. Different disease locations, infectious pathogens, and patients' basic physical conditions will make the specific symptoms vary greatly. There is never a "universal comparison standard."

Last week, I picked up a 28-year-old Internet programmer at the respiratory clinic. He stayed up for 5 consecutive days after winter to work on a project. At first, he just coughed twice when he got up in the morning. He thought it was because the office air conditioner was too dry, so he drank more hot water and ignored it. The cough became worse and worse for three days. He felt chest pain when lying flat at night, and he couldn't even sleep. When he came in, he put the stethoscope in and there were obvious crackles in his right lung. After testing positive for mycoplasma antibodies, he was diagnosed with mycoplasma pneumonia. Many people's understanding of coughs is that "you only cough when you have a cold". In fact, the signals behind different coughs are very different: Dry coughs without phlegm are common in acute pharyngitis, mycoplasma infection, and asthma attacks. If the cough has an obvious "empty" sound, like a puppy barking, you should also be alert to whether it is laryngitis. This condition progresses very quickly in children and can seriously block the airway.

Oh, by the way, a saying that is very widely circulated on the Internet now is that "coughing yellow phlegm means bacterial infection, and you must take antibiotics." In fact, there are different clinical judgment standards for this: in the late stage of viral infection, the airway mucosa falls off and is mixed in the sputum, and yellowish phlegm will also appear. In this case, antibiotics are of no use. Only when the phlegm is thick yellow-green with an obvious fishy odor, accompanied by a high fever that does not subside, and a significant increase in white blood cells in routine blood tests, will the possibility of bacterial infection be considered. There is really no need to look for cephalosporins as soon as you see yellow phlegm.

One symptom that many people tend to overlook is shortness of breath after activity. Last month, a 62-year-old aunt came to see a doctor. She said that in the past half month, she had been out of breath after walking 200 meters to buy groceries. She had to rest three times when climbing two floors. She thought it was because she was too old and lacked strength. However, after a CT scan, it turned out that she had moderate pneumonia and her blood oxygen was only 92%. Our airways are actually like the ventilation ducts at home. If the walls of the airways are swollen or blocked by secretions, the oxygen consumption in the resting state is usually small. However, when the body's oxygen demand increases when it moves, the air supply cannot keep up and it will cause asthma. If you have been exercising well before, but suddenly you feel breathless and have chest tightness when you move even a little bit, don't take it seriously. This is probably because there is a problem with your respiratory tract or lungs.

As for the most familiar symptoms of abnormal secretions and local pain, such as runny nose, nasal congestion, and sore throat, there are actually many misunderstandings: For example, when allergic rhinitis attacks, the nose will run like water, and sometimes half a pack of tissue paper can be used in a day. Many people will treat it as a cold and take cold medicine for a week, which is completely inappropriate.； If your nose is yellow-green and thick, and your forehead is swollen and painful, you most likely have sinusitis. There are also many people who wake up in the morning and blow their noses with bloodshot eyes, so they search Baidu and are scared to think that they have nasopharyngeal cancer. In fact, most of the blood is caused by the air in autumn and winter being too dry and the nasal mucosa is damaged. If there is blood for more than two weeks in a row and is accompanied by a lump in the neck, it is not too late to go for a check-up.

Of course, not all respiratory symptoms occur in the respiratory tract itself. Last week, a junior student came to the doctor. He said that he always felt like there was something stuck in his throat and he couldn't cough it out or swallow it. He thought it was chronic pharyngitis that had not been cured after being treated for more than half a year. I asked him about his usual acid reflux and his tendency to lie down immediately after eating. I asked him to go to the gastroenterology department to check for gastroesophageal reflux. As expected, it was discomfort caused by gastric acid refluxing upwards and irritating the throat. The root cause of the disease was not in the throat at all. Nowadays, many popular sciences like to classify the symptoms of respiratory diseases into upper respiratory tract and lower respiratory tract. In fact, how can there be such an absolute boundary in clinical practice? It is common for upper respiratory tract infections to spread to bronchitis and pneumonia if they are not under control. There is no need to worry about whether you have an "upper" or "lower" infection. As long as the uncomfortable symptoms persist for two or three days, or even get worse, it is more reliable to see a doctor directly.

Finally, I would like to remind you that if the elderly with underlying diseases such as asthma, COPD, or chronic bronchitis suddenly become more familiar with their usual symptoms of coughing and sputum production, or their breathing is worse than usual, they must seek medical treatment in time even if they do not have a fever. Every winter in our department, we encounter elderly people who have to suffer from respiratory failure before they are sent to the hospital. It would have been a pity to intervene early and take some medicine to get better, but in the end they have to be admitted to the ICU for intubation.