Category Archives: Respiratory disease

Pneumonias due to opportunistic infections

These are commonly becoming recognized in the immunocompromised patient. Pneumocystis carinii This is by far the commonest opportunistic infection, accounting for 80% of the cases of pneumonia in patients with acquired immunodeficiency syndrome (AIDS) particularly when the CD4 lymphocyte count is ::5200/mm3 It is also seen in patients receiving immunosuppressive therapy. In the developing world, however, Pne

Mycoplasma pneumonia

This is a common cause of pneumonia. It often occurs in patients in their teens and twenties, frequently amongst those living in boarding institutions. Generalized features such as headaches and malaise often precede the chest symptoms by 1-5 days. Cough may not be obvious initially and physical signs in the chest may be scanty. On chest X-ray, usually only one of the lower lobes is involved but sometimes th

Diseases of the lung parenchyma

PNEUMONIAS Pneumonia may be defined as an inflammation of the substance of the lungs. It is usually caused by bacteria. Clinically it presents as an acute illness characterized in the majority of cases by the presence of cough, purulent sputum and fever together with physical signs or radiological changes compatible with consolidation of the lung. The advent of antibiotics might have been expected to decreas

MANAGEMENT

Asthma is an extremely common disease producing considerable morbidity. The aim of treatment must be: • To abolish symptoms • To restore normal or best possible long-term airway function • To reduce the risk of severe attacks • To enable normal growth to occur in children • To minimize absence from school/work This involves: • Patient and family participation • Avoidance of identified causes where

CLINICAL FEATURES

Patients suffering from asthma exhibit virtually identical symptoms to those suffering from airflow limitation caused by chronic bronchitis and emphysema. Wheezing attacks and episodic shortness of breath are almost universal. Symptoms are usually worst during the night. Cough is a frequent symptom that sometimes predominates and is often misdiagnosed as being due to bronchitis. Nocturnal cough can be a pres

PATHOGENESIS AND PRECIPITATING FACTORS

Occupational sensitizers Over 200 materials encountered at the work-place are known to give rise to occupational asthma. The important causes are recognized occupational diseases in the UK and patients in insurable employment are therefore eligible for statutory compensation provided they apply within 10 years of leaving the occupation in which the asthma developed. The development of asthma following exposu

Asthma

Asthma is a common chronic inflammatory condition of the lung airways whose cause is incompletely understood. Symptoms are cough, wheeze, chest tightness and shortness of breath, often worse at night. It has three characteristics: 1 Airflow limitation which is usually reversible spontaneously or with treatment. In chronic asthma inflammation may lead to irreversible airflow limitation. 2 Airway hyperresponsive

TREATMENT

Postural drainage Postural drainage is of vital importance and patients must be trained by physiotherapists to tip themselves into appropriate positions at least three times daily for 10- 20 min. Most patients find that lying over the side of the bed with head and thorax down is the most effective position. Antibiotics Experience from the treatment of cystic fibrosis suggests that bronchopulmonary infections

Nocturnal hypoxia

It has been shown that patients with chronic bronchitis and emphysema who show severe arterial hypoxaemia also suffer from profound nocturnal hypoxaemia with a Pa02 as low as 2.5 kPa (19 mmHg), particularly during the rapid eye movement (REM) phase of sleep. Because patients with chronic bronchitis and emphysema are already hypoxic, the fall in Pao, produces a much larger fall in oxygen saturation (owing to t

COMPLICATIONS

Respiratory failure The latter stages of chronic bronchitis and emphysema are characterized by the development of respiratory failure. For practical purposes this is said to occur when there is either a Pa02 of less than 8 kPa (60 mmHg) or a Pac02 of more than 7 kPa (55 mmHg). The persistence of chronic alveolar hypoxia and hypercapnia leads to constriction of the pulmonary arterioles and subsequent pulmonary