Respiratory symptoms: cough, sputum, hemoptysis and dyspnea !

Topic

The key questions about cough, phlegm, coughing up blood and breathlessness, and what each answer suggests.

Updated 2026-11-01

See it in 3D: Trachea · Main bronchi

What it is

The four cardinal respiratory symptoms are cough, sputum, hemoptysis and dyspnea, often with chest pain. An orderly history (onset, duration, character, triggers and exposures) points toward the cause before the exam. In Colombia and the region, always ask about tuberculosis and wood smoke.

Key facts

Dyspnea: a subjective feeling of difficult breathing; graded by the activity that brings it on (mMRC scale 0 to 4).
Platypnea: dyspnea on sitting or standing that eases lying down; trepopnea: dyspnea in one lateral position.
Pack-years: packs of cigarettes per day multiplied by years of smoking.
Massive hemoptysis: a large volume in 24 hours or any bleeding that threatens the airway; thresholds vary between sources and it is an emergency.
Pseudohemoptysis: blood from the nose, mouth or pharynx that is spat out without coming from the lung.

Step by step

Cough: 'How long have you had the cough? Is it dry or with phlegm? Is it worse at night, lying down or with exercise?'
Sputum: 'What colour is the phlegm? How much do you bring up a day? Does it smell bad? Have you seen blood?'
Hemoptysis: 'Does the blood come up with coughing or with vomiting? Is it red and frothy? Have you had nosebleeds?'
Dyspnea: 'What activities make you short of breath? Do you get breathless lying flat? Do you wake at night gasping?'
Pain: 'Does the chest pain get worse when you breathe deeply or cough?'
Exposures: 'Do you or did you smoke? How many a day and for how many years? Do you or did you cook with wood?'
Contacts: 'Has anyone at home or work had tuberculosis or a long-lasting cough?'
General: 'Have you had fever, night sweats or weight loss without trying?'

Clinical notes

Chronic cough in non-smokers with a normal radiograph: postnasal drip, asthma, gastro-oesophageal reflux or medicines.
Hemoptysis in the region: tuberculosis, bronchiectasis, lung cancer; also pulmonary embolism and mitral stenosis.
Sudden dyspnea: pulmonary embolism, pneumothorax, pulmonary edema, asthma attack.
Progressive dyspnea: COPD, interstitial lung disease, heart failure, anaemia.
Fever, night sweats, weight loss and prolonged cough: tuberculosis until proven otherwise.

Test yourself

Think of the answer, then tap the question to see it.

From what duration is cough chronic in an adult?

Over 8 weeks; 3 to 8 weeks is subacute and under 3 weeks is acute.

Which features point to hemoptysis rather than hematemesis?

Bright red, frothy blood brought up by coughing, mixed with sputum, without nausea or food particles, and a lung history.

What do orthopnea and paroxysmal nocturnal dyspnea suggest?

Left heart failure with pulmonary congestion, although they can also occur in nocturnal asthma or COPD.

How are pack-years calculated?

Multiply the packs of cigarettes smoked per day by the years of smoking.

Which household exposure matters in a Colombian woman with COPD who never smoked?

Wood smoke from cooking, a frequent cause of COPD in rural areas.

Add to my cards (5)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Cough: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2024); Coughing up blood (MedlinePlus, U.S. National Library of Medicine, 2024); Breathing difficulty: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2024); Pulmonary tuberculosis: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2024).

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Representative model, for educational purposes only.