Respiratory disease in practice - 2003

Comment: A significant new guideline for asthma management
Philip Ind
pp 4-4
The latest issue of Thorax includes a supplement containing the new, evidence-based British guideline on the management of asthma from the British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN). It is the fourth in a series of influential guidelines which began 12 years ago with the publication of two papers in the BMJ (which were subsequently rewritten in 1993 and updated in 1995). So what is new about the latest version?
Management of opportunist mycobacterial infections
L Peter Ormerod
pp 5-7
Opportunist mycobacteria are widely distributed in nature and the number of isolates of such organisms is increasing in HIV-negative as well as HIV-positive individuals. There can be difficulties in making the diagnosis, in differentiating opportunist infection from tuberculosis, in deciding whether there is true infection or merely contamination, and in clinical management. This article gives an overview of these infections and their investigation and management. A more comprehensive review and recommendations are to be found in the Joint Tuberculosis Committee (JTC) 1999 guidelines.
What’s in the asthma pipeline over the next ten years?
Peter J Barnes
pp 8-10
It has proved extraordinarily difficult to develop new classes of drug for the treatment of asthma and most new treatments have been improvements of existing classes of drugs, such as corticosteroids and ß2-agonists. Furthermore, existing treatments for asthma are highly effective if used correctly, so that there is little room for improvement in the management of the majority of patients. However, several new treatments are currently in development for asthma therapy.
How can inhaled steroid therapy be improved?
Philip Ind
pp 11-12
Inhaled corticosteroids are the cornerstone of asthma therapy and are likely to remain so over the next ten years. They have a very broad spectrum of anti-inflammatory effects and clinical benefits in persistent asthma of all grades of severity. They are also generally well tolerated and safe. Local side-effects include sore throat, thrush, and hoarseness, but these are usually relatively easily dealt with. However, inhaled steroids remain unpopular with patients. Patients may fail to distinguish inhaled from oral steroid therapy and may confuse anabolic with corticosteroids.
Cervical mediastinoscopy in the management of lung cancer – a pivotal role
Jonathan I Ferguson and William S Walker
pp 13-15
Patients with non-small cell lung cancer (NSCLC) and known neoplastic deposits in mediastinal lymph nodes before surgery repeatedly show very poor long-term prognoses, even if extensive pulmonary resection is performed. Furthermore, in these patients, perioperative mortality actually exceeds survival. In the absence of distant metastases, staging the mediastinal lymph nodes determines which patients will potentially be cured by surgery.
Blood pressure and obstructive sleep apnoea
Justin CT Pepperell and Robert Davies
pp 16-19
This article discusses the relationship between arterial blood pressure (BP) and obstructive sleep apnoea (OSA). It will briefly discuss the epidemiology of BP and cardiovascular risk with some of the confounders through which a relationship with OSA may be obscured. Why is the question of OSA and BP important and what are the problems that arise in the study of this relationship? Cardiovascular diseases (CVD) (stroke and coronary vascular disease) are the most important causes of mortality in the Western world, and are likely to increase as population levels of obesity increase. Both OSA and hypertension are common.
Air travel for passengers with respiratory disease
Robina K Coker
pp 20-23
In the last 50 years air travel has become increasingly popular. In 1995, 1,285 million passengers flew on commercial flights worldwide; this number has been predicted to exceed 2,000 million by 2005. In-flight medical emergencies have recently attracted much attention from the media, travelling public and aviation industry. The plight of a passenger with a tension pneumothorax, relieved by Professor Angus Wallace with a catheter, coat hanger and brandy bottle, and the death of Emma Christoffersen of venous thromboembolism after a long-haul flight were particularly publicised.