Chronic respiratory distress

CLINICAL DIAGNOSTIC MANUAL

Chronic respiratory distress is a common symptom that can be caused by various respiratory, cardiac, metabolic, or neuromuscular conditions. It is characterised by prolonged dyspnoea that gradually worsens over time, affecting the patient’s functional capacity. Causes range from asthma and chronic obstructive pulmonary disease (COPD) to conditions like obesity, anaemia, or neuromuscular disorders. Correctly identifying the cause of chronic respiratory distress is crucial for establishing appropriate treatment, as some of these conditions require specific interventions, such as managing heart failure or providing oxygen therapy in pulmonary fibrosis.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmed Diagnosis
Obesity	Dyspnoea on exertion, hypoventilation, daytime sleepiness, worsening when lying down.	Elevated body mass index, dyspnoea disproportionate to exertion.	Chest X-ray showing diaphragmatic compression. Arterial blood gases showing hypercapnia.
Allergic asthma	Intermittent dyspnoea, cough, wheezing, exacerbations on allergen exposure.	History of allergies or previous asthma, wheezing, and dyspnoea improving with bronchodilators.	Spirometry showing reversible airway obstruction. Positive allergy tests.
COPD	Progressive dyspnoea, chronic cough with sputum, acute exacerbations.	History of smoking or exposure to pollutants, chronic productive dyspnoea.	Spirometry showing irreversible airway obstruction. Chest X-ray showing pulmonary hyperinflation.
Left ventricular dysfunction	Progressive dyspnoea, orthopnoea, peripheral oedema, pulmonary crackles.	History of heart disease or previous heart failure, dyspnoea worsening when lying down.	Echocardiogram showing ventricular dysfunction. Chest X-ray showing signs of pulmonary congestion.
Anaemia	Dyspnoea on exertion, fatigue, pallor, tachycardia.	Fatigue and dyspnoea disproportionate to exertion, with signs of anaemia on physical exam.	Full blood count showing low haemoglobin and haematocrit.
Pulmonary fibrosis	Progressive dyspnoea, dry cough, crackles at lung bases, clubbing.	Chronic dyspnoea with history of exposure to toxins or autoimmune diseases.	High-resolution CT showing “honeycomb” pattern. Spirometry showing restrictive pattern.
Poor physical fitness	Dyspnoea on exertion, generalised muscle weakness.	History of prolonged sedentary lifestyle, dyspnoea without pulmonary or cardiac findings.	Exercise test revealing low physical capacity without cardiac or pulmonary abnormalities.
Neuromuscular disease	Progressive dyspnoea, muscle weakness, fatigue, nocturnal hypoventilation, difficulty coughing.	Generalised muscle weakness, dyspnoea and fatigue with signs of hypoventilation.	Spirometry showing reduced vital capacity and neuromuscular function tests.
Pulmonary hypertension	Progressive dyspnoea, fatigue, chest pain, syncope in severe cases, signs of right heart failure.	Chronic dyspnoea with history of lung or heart disease, signs of pulmonary hypertension.	Echocardiogram showing increased pulmonary artery pressure. Right heart catheterisation to confirm diagnosis.
Psychogenic cause	Dyspnoea in stressful or anxious situations, no organic findings.	History of anxiety or stress, dyspnoea disproportionate to findings in physical exams or tests.	Diagnosis of exclusion, normal physical exams and imaging tests.
Chronic pulmonary embolism	Chronic dyspnoea, fatigue, chest pain, signs of right heart failure.	History of previous embolism, chronic dyspnoea with signs of pulmonary hypertension.	Lung scan or CT angiogram showing obstruction in pulmonary arteries. Echocardiogram with signs of hypertension.