Respiratory disease in practice - 2000

Comment: Lung function and other organ involvement
Philip Ind
pp 4-4
The intimate involvement of the lung and respiratory disease in conditions affecting other organs is reflected in this current issue of the journal. The lung and the nose are closely associated. The latter is after all the only part of the respiratory tract that is directly accessible – to the fingertip! The importance of postnasal drip and frank rhinosinusitis is emphasised in the articles on cough and asthma, while atopy affecting perhaps one-third of the population also brings in skin disease.
New approaches to future treatments for cystic fibrosis
Daniel Peckham and Christine Etherington
pp 5-8
The identification of the cystic fibrosis (CF) gene sequence in 1989 resulted in an explosion of molecular and cellular research. This has led to a dramatic improvement in our understanding of the pathophysiology of CF and the development of exciting new therapeutic options to combat this disease. Although significant improvements in early diagnosis and conventional therapy have increased life expectancy to a median of 30 years, most patients still die from respiratory failure in early adulthood.
Causes of chronic (obstructive) bronchitis in lifelong non-smokers
Stephen J Connellan
pp 9-11
Several studies carried out over the last 50 years have identified cigarette smoking as the most important factor predisposing to chronic bronchitis in Western Europe and North America. However, the early descriptions of chronic bronchitis and emphysema from Badham and Laennec were made before cigarette smoking was common. Some of the studies documenting the importance of smoking have also shown that chronic cough and expectoration occurs in a significant percentage of lifelong non-smokers. It may be useful therefore, to study factors other than smoking that predispose to chronic bronchitis.
Acute respiratory distress syndrome (ARDS)
Caroline J Bateman and Brian F Keogh
pp 12-15
Acute respiratory distress syndrome (ARDS) represents an ongoing challenge to the critical care physician. Mortality from the syndrome remains high and survivors commonly suffer a stormy course – the management of which is often prolonged, labour-intensive and expensive. Recently, there has been an increasing recognition of post-ARDS morbidity in survivors, which may impact substantially on their quality of life and ongoing healthcare requirements.
Primary ciliary dyskinesia
Mark A Chilvers and Christopher O'Callaghan
pp 16-19
The association of situs inversus and bronchiectasis was first described in 1904. However, it was the Swiss physician, Manes Kartagener, who described the association of sinusitis, situs inversus and bronchiectasis as a clinical syndrome. The relationship between abnormal ciliary function and respiratory problems was first reported in the 1970s. Patients with Kartagener's syndrome were found to have immotile sperm due to the absence of dynein arms within the sperm axoneme. Further studies of cilia from the respiratory tract revealed impaired ciliary beat frequency and deficient dynein arms. Initially, this was called the immotile cilia syndrome.
Chronic cough and oesophageal reflux
Lorcan PA McGarvey and Joe McMahon
pp 20-21
The successful treatment of persistent cough remains a difficult challenge for the practicing physician. Chronic cough, defined as one lasting more than three weeks, may present as an isolated problem, and has been estimated to account for over one-third of new patient referrals to respiratory clinics. Such patients are frequently non-smokers, have a normal chest X-ray and are not taking ACE-inhibitor therapy. In this group the most frequently identified causes of cough are the postnasal drip syndrome (PNDS), asthma and gastro-oesophageal reflux (GOR).
Oesophageal reflux and asthma
Jon Miles
pp 22-23
Asthma is a common chronic condition in the West, with an estimated prevalence of about 5% in the adult population. Gastro-oesophageal reflux (GOR) is also common, with an equivalent prevalence in adults. Symptoms of GOR occur frequently in patients with asthma, with an estimated prevalence between 30 and 89%. This has inevitably led to the suggestion of a causal association between the two conditions.