Volume 16, Number 1

Robert Stockley MD DSc FRCP Director, ADAPT, Lung Investigation Unit, Queen Elizabeth Hospital, Edgbaston

By the year 2020, chronic obstructive pulmonary disease (COPD) will be the third most common cause of morbidity and mortality worldwide. The majority of affected patients have chronic bronchitis and emphysema, and smoking is the major risk factor leading to development of the disease, although in recent years the role of pollution has become more prominent.

Andrew Cummin DM MRCP Senior Lecturer in Respiratory Medicine, National Heart and Lung Institute London and Honorary Consultant, Charing Cross Hospital, London

Breathlessness is one of the most common respiratory symptoms. Always distressing, when sudden or severe it can be alarming for patient and doctor alike. Yet breathlessness does not always receive the attention it deserves. Too often we focus on diseases rather than symptoms, which are of primary concern to patients. To the GP, symptoms are the key to diagnosis, and diagnosis the key to tackling symptoms. This article focuses on the symptom of breathlessness and touches on the complex processes which may enable the GP to reach any one of a large number of possible diagnoses.

Dennis Shale BSc MD FRCP Professor of Respiratory Medicine, University of Wales College of Medicine

The British Thoracic Society guidelines1 on the care of patients with chronic obstructive pulmonary disease (COPD) seek to clarify the diagnosis and management of this group of disorders. By relating grades of severity – based on FEV1 – to the clinical status of individual patients, more appropriate management decisions should be possible, leading to a consistent approach to patients with COPD.

Ling-Pei Ho MB ChB MRCP Respiratory Specialist Registrar, Churchill Hospital, Oxford

In 1980, Furchgott and Zawaddzki showed that the endothelium was essential for the vasodilator action of acetylcholine.1 This action was mediated by a highly unstable substance released by endothelial cells, which they called ‘endothelium derived relaxant factor’ (EDRF). Other endogenous vasoactive substances, including bradykinin, substance P, 5-hydroxytryptamine and thrombin, were found to act through the release of this elusive factor.

David Fishwick MB ChB MRCP (UK) AFOM MD Senior Lecturer in Respiratory and General Medicine, University of Sheffield and Director, Sheffield Occupational and Environmental Lung Injury Centre; Andrew Curran BSc PhD CBiol MIBiol Head, Health Effects Section Health and Safety Laboratory, Sheffield and Director, Sheffield Occupational and Environmental Lung Injury Centre

Respiratory disease may result from a broad spectrum of activities at work, rest or play. In this article, we concentrate on work as an important cause of such disease. Occupational lung disease remains common. Not only does it have major implications for the individual worker, but also has a subsequent wide-ranging impact on colleagues and the workplace.

Philip Ind, Editor

moking remains the largest preventable cause of death and disability. Over 120,000 of the 13 million UK adult smokers die each year from smoking.1 We smoke more heavily than the European average and have more deaths.

John Grange MD MSc Reader in Clinical Microbiology, Imperial College School of Medicine, London

It is common knowledge among medical and lay people that ‘tuberculosis is back’. Numerous reports in the press and on television leave no doubt that the incidence of this disease is rising in developing and developed nations.