So in this lecture, I'm going to discuss the
clinical assessment of patients with lung
disease. We can divide this into three main
factors. One is assessing the epidemiological
factors which are present for the patient:
age, sex, ethnicity, country of origin. The
second is taking a good history. And the third
is examination. The third component (the examination)
I will discuss in a subsequent lecture.
Demography and respiratory disease is important.
It's very important, in fact, because which
disease a patient is likely to have will be
dictated by their age and, to a lesser extent,
by their sex, their ethnic origin, their country
of birth. So for example, somebody who's 20
years old with breathlessness will not have
COPD. They've not had a long enough history
of smoking to develop COPD in almost every
circumstance. Somebody who's born in the UK
and has lived there their whole life and lives
at, say, in a country village rather than
in one of the larger towns like London, is
very unlikely to develop tuberculosis, because
their exposure to tuberculosis is minimal.
So we can divide the lung diseases into three
categories: the ones that really affect younger
people, the ones that affect middle age, and
the ones which are commoner in the elderly.
Now, the ones that affect the middle age and
the elderly overlap largely. But the younger
patient really is not going to get the nasty
diseases such as lung cancer and COPD. So
young adults might have asthma, a pneumothorax,
pulmonary emboli, pneumonia, sarcoidosis.
And some causes of bronchiectasis are common
in young people... are… affect young people,
such as cystic fibrosis, for example.
In the middle age, you start to worry about
lung cancer, obstructive sleep apnea, but
pneumonia is still present. Asthma is still
quite possible. But COPD is coming in as a
potential cause of obstructive lung function
in these patients. And there are other diseases—bronchiectasis,
pulmonary emboli, interstitial lung disease—which
are increasingly common as you get older.
In the elderly, the major lung diseases that
patients get are lung cancer, pneumonia, and
COPD, and pleural problems. But they also
do get bronchiectasis, pulmonary emboli, interstitial
lung disease. And it's not impossible to have
asthma, because they could have had asthma
for most of their life.
There are some respiratory diseases that are
commoner in men and some which are commoner
in women. Examples for men are COPD, lung
cancer, pneumoconiosis (because that's due
to occupational exposure), mesothelioma (again,
because that's due to occupational exposure)
are all commoner in men, as is the primary
pneumothorax, which affects young men. And
sleep apnea seems to be largely a male problem
rather than a female problem, because of the
structure of the back of the pharynx in men
compared to women.
Diseases which are commoner in women are asthma,
obesity hyperventilation, pulmonary emboli
(because of the hormonal relationship), bronchiectasis
(for reasons which are unknown), and primary
pulmonary hypertension, which is a very rare
disease, but a very serious one that affects
largely young women.
Country of origin and disease examples…
Well, things like tuberculosis and HIV infection,
bronchiectasis are much more likely in patients
who are born in the developing countries such
as South Asia or sub-Saharan Africa. There
are some also specific genetic ethnicity issues,
so Afro-Caribbean patients are particularly
likely to get sarcoidosis, and cystic fibrosis
is a genetic problem that affects Caucasians
largely but not explicitly… not exclusively.
So knowing age, sex, ethnic origin, place
of birth gives you a feel for the sort of
diseases the patient is likely to suffer from.