Respiratory medicine is the most clinical of all the medical sub-specialties. Because of the structure of the respiratory tract and the different sound transmitting properties of air, consolidated lung and fluid, a great deal of information can be obtained from physical examination. The lungs are inflated with air, which provides a natural contrast medium for radiological investigation. Respiratory function can be accurately assessed with simple and inexpensive equipment easily used in the general practitioner’s surgery.
Lung problems are common in general practice. History
and examination are invaluable; however considered
selection of investigations can assist the clinician to reach
To outline the indications for common respiratory
investigations to assist in selecting the most appropriate
investigation for a clinical problem related to chronic lung
The vast majority of problems related to chronic
lung disease can be assessed with a full history and
examination, a plain chest X-ray, a spirometer and
a pulse oximeter. Chest X-ray should always be the
initial radiological test. It can distinguish pneumonia
from bronchitis and diagnose breathlessness caused by
pneumonia, heart failure, pneumothorax, pleural effusion
and interstitial lung disease. Computerised tomography
scanning is not a useful test in investigation of symptoms
such as breathlessness or cough when a chest X-ray is
normal. Spirometry can be useful in the evaluation of
chronic cough, wheezing, breathlessness or chest pain.
Baseline oximetry should be performed on all dyspnoeic
patients and those with abnormal spirometry.
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