Attraverso l’esame del respirosi analizzano frequenza, ritmoe profondità del respiro, muscoli respiratori impiegati, tipo di respiro e sforzo connesso. Il respiro normale è un atto automatico, eseguito senza sforzo. L’ inspirio(introdurre l’aria nei polmoni, respirando) avviene per contrazione del diaframma e dei muscoli intercostali esterni che abbassano le basi ed espandono la gabbia toracica in avanti. L’ espirio(mandare fuori dai polmoni l’aria inspirata) è passivo per il ritorno elastico della gabbia toracica. L’esame del respiroin persone affette da BPCO (pneumopatia cronica ostruttiva) rileva un espirio prolungato e i pazienti tendono a espirare con la bocca chiusa per aumentare la pressione tele-espiratoria.
Frequenza respiratoria
Il respiro normale (eupnea) è appena udibile, con espirio lievemente più protratto dell’inspirio. La frequenza respiratoria normale è di 14-20 atti al minuto. Il respiro è caratterizzato da periodi di sospiri, meccanismo per resettare le forze in gioco nelle vie aeree più periferiche.
Approccio al malato con problemi respiratori
L’approccio al malato con problemi respiratori oltre l’esame del torace, deve includere la ricerca di manifestazioni extrapolmonari.
Consunzione e febbricola in un paziente con tosse cronica, che vive in ambiente sovraffollato, specie se proviene dall’Africa e dall’Est Europa, devono indurre ad escludere la diagnosi di tubercolosi.
Un paziente con dita a bacchetta di tamburo e unghie a vetrino d’orologio, dimagrito, forte fumatore con tosse cronica, potrebbe invece essere affetto neoplasia polmonare.
Assenza del polso radiare è carotidodinìa in una giovane donna orientale, dimagrita, febbre e con tosse secca, potrebbero rientrare verso la malattia di Takayasa.Â
Piccole teleangectasie sulla cute delle mani, sulle labbra in un paziente con dispnea possono essere segni di sclerodermia.Â
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