Comment: Life and death decisions in respiratory failure
Philip Ind
pp 4-4
Good practice and, increasingly, trust guidelines, dictate that firm decisions about mechanical ventilation and attempted resuscitation should be made as early as possible. Ideally, discussion of the issues should take place on admission. However, this is usually not possible with the patient himself. Abnormal blood gases may prevent understanding of difficult concepts (let alone legal competence). Common sense suggests that it may be distressing and inappropriate to discuss such issues with a patient who is already acutely ill and may be too breathless to talk!
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Contact screening for tuberculosis
John P Watson
pp 5-7
Tuberculosis is on the increase in Britain. After a century of declining incidence, the trend has been reversed since the late 1980s. The number of cases notified in England and Wales in 2000 was 6,797, an increase of 10.6% over 1999. Recent well publicised outbreaks, such as the one centred on a Leicester school, have increased public awareness of the disease. People have been alerted to the possibility of the disease, and to the importance of measures to control it. However, media attention may also result in heightened and often misplaced anxiety about the risks of tuberculosis.
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Spirometry in general practice – where are we now?
David MG Halpin
pp 8-11
No doctor or nurse would contemplate diagnosing or treating hypertension without measuring the patient's blood pressure, yet every day diagnoses of COPD are made – and therapy is adjusted – without measuring patients’ airway calibre. Spirometry is a quick and accurate way of assessing the severity of airflow obstruction, but there still appears to be considerable apprehension about its use in primary care.
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The role of exercise testing in patients with lung disease
Stanley B Pearson
pp 12-16
Cardiopulmonary exercise testing has an important role to play in the patient with lung disease, and the aim of this short article is to provide an introduction to the physiological principles underlying it and to give some examples of its application in relation to breathless patients. The role of testing includes: diagnosis, including the investigation of unexplained breathlessness and the detection of early occult disease; assessment of the response to interventions and treatment; measurement of exercise capacity, including assessment of impairment or disability and fitness for thoracic surgery.
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Weaning from mechanical ventilation – Part 2
Ian Sutcliffe and Mark W Elliott
pp 17-19
In the previous issue of RDIP, Part 1 of Weaning from mechanical ventilation discussed strategies for discontinuing mechanical ventilation in patients in the ICU. Part 2 takes a more in-depth look at the weaning process itself, and at the relative pros and cons of the various techniques. By the mid-1990s, a two-step approach to weaning was emerging.
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Chronic irritant exposures and asthma
Samuel C Stenton
pp 20-23
In 1985, Brooks and colleagues described ten subjects who developed persisting asthma following a single, brief, high-level exposure to an inhaled ‘irritant’. The wheezing began within 24 hours of the exposure, and often immediately. The authors coined the term Reactive Airway Dysfunction Syndrome (RADS) and devised diagnostic criteria. The rapid onset of symptoms indicated that hypersensitivity was not likely to be involved and this distinguished RADS from other forms of occupational asthma.
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