Respiratory disease in practice - 2001

Comment: Respiratory medicine in the news
Philip Ind
pp 4-4
Respiratory medicine is currently in the news. The recent British Thoracic Society press release highlights The Burden of Lung Disease. This report, compiled by the Department of Public Health at Oxford University, summarises the total burden of lung disease in the UK in terms of deaths, disability and economic costs. Respiratory disease, including carcinoma of the bronchus, now causes more deaths than heart disease or other cancers, killing more than one in four people.
Effect of inhaled corticosteroids on bone
Nicola Peel
pp 5-7
Current guidelines for the management of asthma advocate early intervention with inhaled corticosteroids. These agents are also widely used in the management of chronic obstructive pulmonary disease (COPD). Three compounds are licensed in the UK; beclometasone dipropionate (BDP), budesonide (BUD) and fluticasone propionate (FP). Estimates suggest there are approximately one million adult users of inhaled corticosteroids in the UK. Oral corticosteroids in the treatment of respiratory disease are firmly associated with osteoporosis and increased fracture risk.
Pulmonary rehabilitation in chronic lung disease
Michael Morgan
pp 8-9
In the UK the management of incurable chronic disease is generally neglected in favour of the emphasis on acute emergency care or surgical procedures. This may be an expedient policy in a financially restrained health service, but in other countries where the true burden of chronic disease is recognised, such neglect is evidently not tolerated. The true scale of chronic disabling lung disease in the UK is unknown but likely to be considerable. The most common chronic lung disease is COPD, which accounts for approximately a quarter of acute hospital medical admissions.
The role of viruses in asthma and COPD
Terence Seemungal and Jadwiga A Wedzicha
pp 10-13
This review considers the incidence of respiratory virus infections in asthma and COPD, their effects on symptomatology, airway inflammation, morphology and physiology. Co-factors of virus infection and possible mechanisms of infection are also discussed. Recently emerged evidence for chronic viral infection in COPD will be explored. In a study of 44 patients with chronic bronchitis over two years, Stott et al found rhinovirus in 13 (14.9%) of 87 exacerbations of chronic bronchitis including four sputum specimens which were positive, though the corresponding throat swabs were not.
BCG vaccination in the UK
Peter DO Davies
pp 14-16
BCG is an attenuated form of Mycobacterium bovis, which was developed by two French men – Calmette and Guerin – by passage of the bacillus over 100 times. It was ready for trials in the 1920s. Unfortunately, in 1927 there was a mixup of vaccine with live M tuberculosis in Lubeck and infants were injected with the live tubercle bacillus instead of BCG. Many of them died and it took many years for BCG to get over its erroneously earned bad reputation.
COPD guidelines – beneficial or irrelevant?
John A Hughes
pp 17-19
The British Thoracic Society (BTS) published its Guidelines for the management of chronic obstructive pulmonary disease in 1997. These guidelines summarised the views of many individuals and organisations, and were based on a combination of clinical judgement and a review of the literature on the subject.
Paediatric applications of non-invasive ventilation
Anita K Simonds
pp 20-23
There has been an almost exponential growth in the use of non-invasive ventilation (NIV) in the last decade. This is largely due to the recognition that non-invasive nasal mask ventilation can reduce mortality and morbidity in a range of acute and chronic pulmonary disorders in adults. In parallel to these widening indications, improvements in ventilator and mask design have taken place.