Volume 15, Number 4

Lindsey Dow DM FRCP Consultant Senior Lecturer, Care of the Elderly, University of Bristol, Frenchay Hospital

Older people presenting with acute or chronic respiratory symptoms are a familiar and regular occurrence in primary and secondary care, and a significant proportion will have asthma or COPD. Worldwide demographic changes are resulting in a considerable increase in the proportion of the population aged 80 years and over, of whom 5–8% will have asthma. Increasingly, gerontologists are emphasising the diversity seen in old age and the danger of generalisation in the approach to management.

Waldo Mattos MD Visiting Research Fellow; Sam Lim MB BS FRACP Clinical Research Fellow, National Heart and Lung Institute, London

Leukotrienes (LTs) are potent pro-inflammatory mediators produced by different cells including mast cells, basophils, eosinophils and macrophages.1 Following cellular activation, arachidonic acid is released from membrane phospholipids by the action of phospholipase A2 and subsequently metabolised by the enzyme 5-lipoxygenase to produce LTs. This includes LTC4, LTD4 and LTE4, also known as cysteinyl LTs by virtue of containing a cysteine residue.

Stephen Banham MD FRCP(Edin&Glas) Consultant Physician, Director Sleep Breathing Service, Glasgow Royal Infirmary

Non-invasive ventilation (NIV) has a long history in the form of the negative-pressure ventilators (iron lungs). However, it was not until the advent of effective nasal masks and compact positive-pressure-flow generators in the late 1980s, that this form of treatment could be actively explored across a range of respiratory disorders.

Kathleen Liddle RGN Dip Adv Nurs Cystic Fibrosis Liaison Sister, Western General NHS Trust, Edinburgh

With the average life expectancy of cystic fibrosis (CF) patients in the UK approaching 31 years,1 CF has long ceased to be a disease of childhood. The nature of the disease demands that the treatments required to maintain optimum health, such as physiotherapy, nebulised therapies, antibiotics and nutritional supplementation are time-consuming, relentless and expensive.2 The effect of this on the quality of life may be significant. This article discusses the potential benefits of home vs hospital treatments.

John Wort BA MRCP Specialist Registrar in Respiratory Medicine, Department of Transplant Medicine, The Royal Brompton and Harefield NHS Trust

Mycoplasma pneumoniae is an ‘atypical agent’, which causes a significant proportion of community-acquired pneumonia. The spectrum of illness varies from mild upper respiratory tract symptoms to severe and possibly fatal pneumonia. The organism is characterised by its ability to produce many extrapulmonary manifestations, which can dominate the clinical picture.

Huw Lloyd MB BChir FRCGP GP, Old Colwyn

Winter brings its own particular problems for GPs and their patients. The increase in the number of patients with respiratory tract infections adds to the workload of the GP and to the misery of the patient.

Neil Gibson MD FRCPCH Consultant in Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Glasgow

Sleep disordered breathing in children is still a generally neglected area. As in most areas of paediatrics, the problems are not the same as those seen in adulthood. Any parent can tell you that behavioural and psychosocial problems related to sleep are very common in childhood. However, the morbidity of disorders of breathing control, airway obstruction and the night-time effects of asthma, cystic fibrosis and neuromuscular disorders are still unclear.

John Diggle MB BCH GP, Caerleon, Newport

Spirometry is an investigation which, although relatively simple, is regarded by many GPs as being in the remit of secondary care. However, the management of chronic disease is one of the most important roles of the GP and if the GP wishes to diagnose and manage chronic obstructive pulmonary disease (COPD) to an acceptable standard, then spirometry becomes an essential part of practice.