Respiratory disease in practice - 2000

Comment: When should antibiotics be used for respiratory tract infections in adults?
Philip Ind
pp 4-4
GPs and patients are frequently exhorted to avoid antibiotics. In this issue of the journal, Dr Anne Thomson reviews the use of antibiotics in respiratory tract infections in children. She concludes that antibiotics are only needed in pneumonia which is severe, associated with a high fever or not improving after 48 hours. We have previously discussed the need to define ‘chest infections’ or lower respiratory tract infections in terms of acute bronchitis or pneumonia. Antibiotics are not indicated for acute bronchitis in adults in good respiratory health nor in uncomplicated asthma.
Antibiotics and respiratory tract infections
Anne H Thomson
pp 5-7
Respiratory tract infections – predominantly viral – are common in children. The preschool child, for example, averages between six and ten respiratory infections a year, mostly during the winter. Despite their likely viral aetiology, antibiotics are often prescribed for these illnesses. Inappropriate antibiotic prescribing is a growing cause of concern. Even though antibiotics are not available over the counter in the UK, as they are in some countries, antibiotic resistance is rising. This is important both for public health and the individual.
Investigation and treatment of pulmonary embolism
Noeleen M Foley
pp 8-10
Few acute conditions have such a wide spectrum of severity or variety of presentation as acute pulmonary embolism (PE). Its incidence is not known but is estimated at approximately 25 per 100,000 of the population per year in the UK, although many cases are diagnosed postmortem in association with advanced malignancy, cardiac problems or respiratory disease. PE is part of the spectrum of disease that includes the far more common condition of deep vein thrombosis (DVT).
COPD guidelines – what effect have they had?
Michael Rudolf
pp 11-13
The British Thoracic Society (BTS) guidelines for the management of chronic obstructive pulmonary disease (COPD) were published in December 1997 and reviewed in this journal early in 1998. Previous experience in producing asthma guidelines highlighted the importance of not simply publishing guidelines but also of having a strategy for the dissemination and implementation of their recommendations into clinical practice.
Lung reduction and the relief of severe emphysema
Michael Davies and Duncan Geddes
pp 14-16
Lung reduction surgery is an emerging option in the treatment of severe pulmonary emphysema. This article describes the procedure, nominates those who may benefit from it (and the degree of benefit) and considers the questions that remain unanswered. Pulmonary emphysema is an important cause of morbidity (frequently involving the services of GPs and hospitals) and mortality (6.4% of all male deaths and 3.9% of all female deaths in 1992).
Home-based oxygen therapy for COPD
Tim Howes and David Green
pp 17-20
The use of home oxygen therapy in chronic obstructive pulmonary disease (COPD) has been discussed recently in this journal, and its benefits are well established. Although pertinent issues on the use of oxygen therapy in COPD have been incorporated into guidelines in the UK and other countries, many prescriptions for long-term oxygen therapy (LTOT) do not conform to these guidelines.
Investigating cough-variant asthma in children
Caroline Pao and Sheila McKenzie
pp 21-23
Respiratory illnesses account for more than half of all illness in the preschool age group and account for one third of GP attendances in children under 11 years old. Part of the symptomatology is recurrent or persistent cough (PC). Cough-variant asthma in children is typically nocturnal, triggered by upper respiratory tract infections (URTIs), cold weather and exercise. Recurrent cough is mentioned in the guidelines for the diagnosis and management of asthma, but the guidelines acknowledge that the criteria for defining asthma in the presence of recurrent cough need to be clarified.