Comment: A NICE Cinderella
Rob Primhak
pp 4-4
As a paediatrician preparing the Comment for the autumn edition of RDIP, I was struck by the rather sparse paediatric content on this occasion, and sought to redress the balance by sharing one of the problems with which we are currently wrestling. With the virus-ridden winter months looming, the prospect of another bronchiolitis season is never a cheerful thought.
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Acute COPD and non-invasive positive pressure ventilation
Salim PL Meghjee and Paul K Plant
pp 5-8
Since the 1950s, endotracheal intubation (ETI) and invasive mechanical ventilation (IMV) has been the only common method of offering ventilatory support to patients with COPD who are deteriorating despite medical therapy. This technique is associated with significant complications, including ventilator associated pneumonia. However, since the early 1990s interest has increased in the use of non-invasive ventilation (NIV) where ventilatory support is delivered via a face or nasal mask, with the patients maintaining their own airway.
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Drug-resistant tuberculosis
Peter Ormerod
pp 9-11
Drug resistance in tuberculosis has been around as long as the TB drugs themselves. After the introduction of streptomycin, isoniazid and para-amino-salicylic acid (PAS), it took several years to realise that spontaneous mutations allowed drug resistance to develop at an approximate rate of one in 10 organisms. Combination chemotherapy was needed to treat tuberculosis effectively, and to prevent the emergence of drug resistance. In 1960 over 10% of patients with tuberculosis and a history of prior treatment had drug resistance.
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Preoperative evaluation
Tamara Shiner and Robert J Shiner
pp 12-14
The risk of any operation will depend on the type and site of the operation, and the type of anaesthetic, as well as the condition of the patient. The risk can be minimised by the use of local or epidural anaesthesia if appropriate. For example, in the case of prostatic surgery, the risk can be considerably higher if performed under general anaesthesia and via an abdominal approach than if the operation were performed under epidural anaesthesia and via a transurethral approach.
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Steroid usage in the treatment of COPD
Peter J Barnes
pp 15-17
Inhaled corticosteroids are now widely used in the treatment of chronic obstructive pulmonary disease (COPD) in the UK. This is often inappropriate and indeed patients may suffer from systemic side-effects. COPD is associated with chronic inflammation in the airways and lung parenchyma. This has been used as a rationale for the use of inhaled corticosteroids in COPD by analogy with the striking suppressive effects of inhaled corticosteroids on airway inflammation and symptoms in asthma. But the inflammatory patterns in the two differ markedly.
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Metastatic renal cell carcinoma mimicking a pleural mesothelioma
Dev Banerjee, Himender K Makker and Peter B Iles
pp 18-19
A 67-year-old male Caucasian ex-smoker presented with a one-month history of cough, exertional breathlessness, poor appetite, feeling unwell and with having a painful left hip. He gave an eight-year history of heavy asbestos exposure during his naval service until 1954. He had no haemoptysis, chest pain, weight loss, abdominal pain or haematuria. He had undergone a prostatectomy for benign prostatic hyperplasia two years earlier.
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How can physiotherapy help the respiratory patient?
Jennifer A Pryor
pp 20-23
The patient with respiratory disease is usually well investigated and on optimal medical management, but could quality of life be further improved by referral for a physiotherapy assessment? Physiotherapy techniques may help by reducing the work of breathing, aiding mucociliary clearance, and increasing exercise capacity. The normal breathing pattern is usually lost in the breathless patient and use of the accessory muscles of respiration increases the work of breathing. Breathing control, where relaxation of the upper chest and shoulders is encouraged together with gentle breathing using the lower chest, often helps to relieve breathlessness by reducing the work of breathing.
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