Factors That Aggravate

Factors That Relieve

Associated Symptoms


Exertion, lying down

Rest, sitting up, though dyspnea may become persistent

Often cough, orthopnea, paroxysmal nocturnal dyspnea; sometimes wheezing

History of heart disease or its predisposing factors

Exertion, inhaled irritants, Expectoration; rest, though respiratory infections dyspnea may become persistent


Rest, though dyspnea may become persistent

Chronic productive cough, recurrent respiratory infections; wheezing may develop

Cough, with scant mucoid sputum

History of smoking, air pollutants, recurrent respiratory infections

History of smoking, air pollutants, sometimes a familial deficiency in alpha^antitrypsin

Variable, including allergens, irritants, respiratory infections, exercise, and emotion


Separation from aggravating factors

Rest, though dyspnea may become persistent

Wheezing, cough, tightness in chest

Often weakness, fatigue. Cough less common than in other lung diseases

Environmental and emotional conditions

Varied. Exposure to one of many substances may be causative.

Pleuritic pain, cough, sputum, fever, though not necessarily present

Pleuritic pain, cough


Often a previously healthy young adult

More often occurs at rest than after exercise. An upsetting event may not be evident.

Breathing in and out of a paper or plastic bag sometimes helps the associated symptoms.

Often none. Retrosternal oppressive pain if the occlusion is massive. Pleuritic pain, cough, and hemoptysis may follow an embolism if pulmonary infarction ensues. Symptoms of anxiety (see below).

Sighing, lightheadedness, numbness or tingling of the hands and feet, palpitations, chest pain

Postpartum or postoperative periods; prolonged bed rest; congestive heart failure, chronic lung disease, and fractures of hip or leg; deep venous thrombosis (often not clinically apparent)

Other manifestations of anxiety may be present.

TABLE 6-3 ■ Cough and Hemoptysis*


Cough and Sputum

Associated Symptoms and Setting

Acute Inflammation

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