Evaluation

Diagnostic Features

• Acute or chronic
  • acute:
    viral nasopharyngitis or laryngotracheobronchitis inhalation allergenic or irritative substance
  • chronic:
    chronic bronchitis (cough with sputum for 3 months in 2 consecutive years), bronchiectasis, tuberculosis, carcinoma, asthma
• Productive or nonproductive
  • productive with underlying inflammatory process
  • nonproductive: mechanical or irritative stimulus
• Type and quantity of sputum
  • foul smelling: anaerobic infection abscess/necrotizing pneumonia
  • abundant frothy/salivalike sputum: bronchoalveolar carcinoma
  • pink-tinged, foamy sputum: pulmonary edema
  • rust-colored: pneumococcal pneumonia
  • chronic copious purulent sputum ñ blood streaking: bronchiectasis
• Character
  • brassy: from major airways involvement/tracheal disease
  • barking or croupy: laryngeal disease
  • paroxysmal whoops: pertussis
  • nocturnal: congestive cardiac failure or asthma; gastroesophageal reflux
  • meals: hiatal hernia or gastroesophageal reflux
  • ams: severe bronchitis or bronchiectasis
• Time relationships
• Associated features
  • wheezing
  • stridor
  • fevers and chills
  • weakness and weight loss
  • recurrent pneumonias
  • smoking history
  • repeated throat clearing/sensation of phlegm in throat
  • occupational history

Physical Examination

• Breathing pattern and rate
• Accessory muscle use
• Lungs: wheezes and rhonchi, crackles, dullness to percussion
• HEENT: hairs on tympanic membranes, nasal mucosal edema/polyps, oropharyngeal secretions, sinus tenderness
• Neck: mass or enlarged thyroid

Roentgenographic Examination

• PA and lateral chest
• Paranasal sinuses
• CT thorax

Laboratory Examination

• Eosinophils
• IgE
• ESR or specific testing for collagen vascular disease, sarcoidosis, infection

Pulmonary Function Testing

• Spirometry
• Volumes
• Bronchoprovocation testing

Fiberoptic Bronchoscopy