Respiratory Disease Testing: From physical examination to invasive biopsy techniques

Respiratory disease refers to pathological conditions influencing the tissues and organs that enable the gas exchange in higher organisms and consists of conditions of bronchi, alveoli, upper respiratory tract, bronchioles, pleural cavity, pleura, trachea, and the nerves & muscles of breathing. Respiratory disease encompasses pulmonary embolism, bacterial pneumonia, common cold, acute asthma, and lung cancer. The initial diagnostic step is always taking a cautious clinical history. The certain respiratory signs consist of abnormal breath sounds, dyspnea, hemoptysis, cough with or without sputum production, snoring and chest pain.

Physical examination typically follows a series: inspection, palpation, percussion, and auscultation. Inspection may display vital physical symptoms such as abnormal breathing patterns, cyanosis, chest wall deformities, finger clubbing, edema, Horner’s syndrome, or superior vena cava syndrome. The physical examination and clinical history give the necessary hints towards the probable underlying respiratory disease, directing the selection of the suitable diagnostic examinations, such as laboratory tests, respiratory function tests, imaging techniques, and/or biopsy procedures.

Laboratory tests:

Apart from routine laboratory urine and blood tests, numerous specific tests are available for respiratory diseases, for instance, D-dimer test for pulmonary embolism. Analysis of sputum consists of cell differentiation, bacteriological examination, and estimation of several inflammatory mediators. Exhaled nitric oxide fraction and exhaled breath condensates or exhaled gasses, such as carbon monoxide are utilized as markers of inflammatory and other diseases.

Respiratory function tests

The significant clinical functions of respiratory function tests consist of an assessment of severity, diagnosis, evaluation of prognosis, and monitoring treatment. The respiratory function tests comprise lung capacity and airway resistance, spirometry, diffusing capacity, blood gas analysis, cardiopulmonary exercise testing, respiratory muscle function measurement, control of ventilation, diagnosis of sleep breathing disorders, right heart catheterization, and intensive care monitoring.

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Imaging techniques

The several imaging techniques utilized in respiratory disease testing includes chest radiography, computed tomography, pulmonary and bronchial angiography, fluoroscopy, magnetic resonance imaging, ultrasonography, and nuclear medicine techniques.

Invasive biopsy techniques

Biopsy and endoscopy techniques are necessary tools in several respiratory diseases when easy laboratory and clinical methods of examination have failed to give in a diagnosis. The outcomes of biopsies are greatly reliant upon the quality of the microbiological and pathological investigations. It includes bronchoscopy, bronchoalveolar lavage, autofluorescence and narrow-band imaging, percutaneous needle biopsy, thoracentesis & pleuroscopy, and surgical methods.