Comment: Why we need a higher profile for lung disease
Philip Ind
pp 4-4
We have a new government. We also have a new set of promises on delivery of healthcare. On top of national targets for cancer, heart disease and mental health come the National Service Frameworks (NSFs) for renal disease, care of older people and children’s health. Lung diseases remain low priority despite their importance. Would an NSF for lung disease – as called for by the chairman of the British Thoracic Society – help?
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Tobacco and teens: the ‘Be Smart – Don’t Start!’ campaign
Stephen Connellan
pp 5-7
Many years ago, a recreational drug, packaged in a handy inhaler device, was introduced to this country. Initially used by adult males, it subsequently also became popular with females. Its use became socially accepted and widespread; but unfortunately, clear evidence came to light that the packaging caused or contributed to several types of cancer, heart attacks, arterial damage and blockage, bronchitis and emphysema and many other health hazards which may also affect bystanders who are not followers of the habit.
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Anaphylaxis
William Egner
pp 8-11
Anaphylaxis is the most severe form of allergic reaction, often resulting in life-threatening dyspnoea or hypotension. It was initially described in 1901 by Porter and Richet, as the opposite of the prophylaxis induced by repeated vaccination; in this case after repeated immunisation, severe reactions occurred. Anaphylaxis results from extensive degranulation of mast cells and/or basophils, which release pre-formed mediators resulting in a wide variety of clinical manifestations. The trigger is usually mediated by antigen-specific IgE (type 1 hypersensitivity).
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Weaning from mechanical ventilation – Part 1
Ian Sutcliffe and Mark W Elliott
pp 12-14
The need for invasive mechanical ventilatory support is the most common reason for admission to intensive care units (ICUs), and can arise as a result of a diverse range of disease states that, either directly or indirectly, cause acute respiratory failure. In some cases, ventilatory support can be withdrawn rapidly once the original insult has been reversed. In other circumstances, ‘weaning’ from ventilatory support can be difficult and time consuming, and the outcome can be unpredictable.
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Hyperventilation
Christopher Bass
pp 15-17
Primary care doctors and chest physicians have always dealt with large numbers of patients in their clinics who report symptoms of breathlessness which are out of proportion to the organic findings. Different terms have been proposed for these patients, including ‘hyperventilation syndrome’, ‘unexplained breathing disorder’ and ‘behavioural breathlessness’. Hyperventilation and hyperventilation syndrome have had a chequered history over the last 20 years, with some people even expressing doubt as to whether a discrete ‘hyperventilation syndrome’ exists at all.
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Drug delivery developments
Mark Everard and Nicolas Cobos
pp 18-20
Aerosol therapy has been used for hundreds of years to treat a variety of pulmonary diseases such as asthma, COPD and cystic fibrosis. Aerosol therapy was used initially because the speed of onset of drugs such as anticholinergics and beta2-agonists is much greater when inhaled as compared with oral therapy. In addition, the inhaled route confers benefits in terms of the therapeutic index for drugs such as beta2-agonists, inhaled corticosteroids and aminoglycoside antibiotics.
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Thoracoscopy and video-assisted thoracic surgery
JAC Thorpe
pp 21-23
In recent times thoracic surgeons have focused on exploring minimally invasive surgical techniques. There are now several different approaches to the thoracic cavity and the mediastinum, for example muscle-sparing thoracotomy and video-assisted thoracic surgery (VATS). Post-thoracotomy pain was a common problem in traditional posterolateral thoracotomy, occurring in up to 25% of patients. This problem had spurred surgeons on to develop more minimally invasive techniques.
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