Respiratory disease in practice - 2005

Spring 2005, Volume 20 Number 2

The management of pleural effusion
Nicholas Chanarin and Prina Ruparelia
pp 5-6
The pleural space is the area between the lung and the chest wall. It is lined by two thin serous membranes, the visceral and parietal pleura. This space is bathed in pleural fluid. If fluid builds up and exceeds 100 ml on one side, then patient is said to have a pleural effusion. In good health, there is regular turnover of pleural fluid. Fluid oozes out from the parietal pleura driven by relatively high pressure in the parietal capillaries. The fluid is reabsorbed through the visceral pleura where the pulmonary capillaries are at a lower pressure.

Comment: Respiratory research in the UK and the rest of the world
Philip Ind
pp 2-2
A recent paper has audited respiratory research activity and examined published output from various countries, and compared this with national disease burden. Funding of respiratory research in the UK was also reported. This raises interesting questions regarding research priorities – who should decide them, how they are funded and the breakdown between basic and clinical research. Rippon et al undertook a trawl of papers and reviews related to respiratory medicine between 1996–2001, identified from the Science Citation Index. They used a specially designed title keywords and specialist journal ‘filter’.

Optimising the use of inhaled corticosteroids in Step 2 asthma therapy
Philip Ind and Maria Hansson
pp 7-8
Asthma poses one of the greatest challenges to the management of chronic disease in primary care and consumes a large portion of NHS resources. The importance of asthma from a public health perspective is emphasised by its inclusion as one of ten clinical priorities in the new General Medical Services (GMS) contract which came into effect in April 2004.

Open access lung function in primary care – are our patients coming to blows?
Brendan Cooper
pp 9-11
The use of lung function services in general practice is increasing across the UK, largely because of the introduction of the British Thoracic Society (BTS) guidelines recommending spirometry for the management of chronic obstructive pulmonary disease (COPD). These guidelines place an emphasis on the measurement of forced expiratory volume in one second (FEV1) together with other spirometric indices (forced vital capacity [FVC], vital capacity [VC] and peak expiratory flow [PEF]) as an opportunistic screening test for patients dropping in to the practice.

Concordance in asthma: optimising prescribing of inhaled corticosteroids
Martin Duerden and Stephanie Wolfe
pp 12-13
The term ‘concordance’ in relation to prescribing and medicine-taking came into common use following a report published by the Royal Pharmaceutical Society of Great Britain in 1997, From compliance to concordance. Compliance is the extent to which a person takes or uses a medicine as intended by the prescriber (who may be a doctor, and now, other healthcare professional). Concordance is the partnership between a patient and healthcare professionals in which an agreement is reached about how medicines are to be taken or used.

Primary care research comes into its own at ERS congress
Hilary Pinnock and David Price
pp 14-15
The key role of primary care in the area of respiratory disease, and its growing contribution to research, was recognised in a two-day primary care conference during the 2004 European Respiratory Society (ERS) congress in Glasgow. Organised jointly by the ERS, the General Practice Airways Group (GPIAG), the National Respiratory Training Centre (NRTC) and the Respiratory Education and Training Centre (RETC), the conference attracted a broad range of delegates – a clear indication of the impact of the General Medical Services (GMS) contract and other initiatives highlighting respiratory disease in primary care.