Respiratory disease in practice - 2004

November 2004, Volume 20 Number 1

New developments with Streptococcus pneumoniae
Jim Catterall
pp 1-5
Most cases of community-acquired pneumonia are caused by Streptococcus pneumoniae. Bacteraemic pneumococcal pneumonia still has a mortality rate of 7–35%. The most susceptible patients are the young and the old, and the organism also causes other respiratory tract infections, as well as otitis media and meningitis. In underdeveloped countries an estimated five million children under the age of five die each year from acute lower respiratory tract infections in which S pneumoniae is probably the primary agent. The pneumococcus is also becoming less sensitive to penicillin.

Respiratory epidemics: a review of 2004
Philip Ind
pp 2-2
2004 is a year of respiratory epidemics and the impact of respiratory disease on the nation’s health is detailed in Lung Report III – Casting a shadow over the nation’s health from the British Lung Foundation; it is all about epidemics. Asthma continues to be a huge problem, with 3.7 million adults and 1.4 million children currently receiving treatment in the UK. New guidelines for COPD management have been agreed and published by the National Institute for Clinical Excellence (NICE). Lung cancer is now the most common cancer affecting women, though there is recent evidence of improved outcomes in the UK.

Diving and lung disease – principles and implications
Graeme P Currie and David J Godden
pp 6-8
Underwater diving as a recreational pursuit is becoming increasingly popular. Medical practitioners may face requests to evaluate and treat frequently encountered diving-related illness and injury and to advise on aspects of fitness to dive. Most reputable diving clubs and organisations will require that divers consider their fitness for the sport, as potentially avoidable mishaps may have implications not only for the diver, but for their diving companions and their insurance. It should be understood, however, that except in the commercial situation, doctors can advise the diver on potential risks, but they have no legal authority to prevent the individual from diving.

Imaging in the diagnosis of pulmonary thromboembolism – current perspectives
Edwin JR van Beek and Eleanor Lorenz
pp 9-12
Pulmonary embolism is now recognised as part of the spectrum of venous thromboembolic disorders. Pulmonary thromboembolism (PE) is a major cause of morbidity and mortality, with an annual incidence in the Western world around 0.5 per 1,000. PE that is recognised and treated with adequate anticoagulation has a mortality rate of less than 2.5%, but, untreated, this rises to 30%.

Oxygen therapy in acute exacerbations of COPD
Alan Fletcher
pp 13-15
Most of us can recall a teaching session as an undergraduate or junior doctor in which the danger of oxygen for patients with chronic obstructive pulmonary disease (COPD) was explained in gripping fashion. Suddenly, the gas that we considered life-saving was revealed as a potential sinister killer. In current practice, oxygen, administered in good faith before arrival in hospital, is frequently withheld from patients with acute exacerbations of COPD in hospital. This article considers the role of oxygen in these patients and puts the risks into perspective.