Volume 17, Number 3

Salim PL Meghjee, Specialist Registrar, York District Hospital; Paul K Plant, Consultant Physician, Dept of Respiratory Medicine, St James’s University Hospital, Leeds

Since the 1950s, endotracheal intubation (ETI) and invasive mechanical ventilation (IMV) has been the only common method of offering ventilatory support to patients with COPD who are deteriorating despite medical therapy. This technique is associated with significant complications, including ventilator associated pneumonia (see Table 1).1,2

Dev Banerjee MRCP Specialist Registrar; Himender K Makker MD MRCP Senior Registrar; Peter B Iles MD FRCP Consultant Physician, Department of Respiratory Medicine, Clinical Investigation Unit, City Hospital NHS Trust, Birmingham

A 67-year-old male Caucasian ex-smoker presented with a one-month history of cough, exertional breathlessness, poor appetite, feeling unwell and with having a painful left hip. He gave an eight-year history of heavy asbestos exposure during his naval service until 1954. He had no haemoptysis, chest pain, weight loss, abdominal pain or haematuria. He had undergone a prostatectomy for benign prostatic hyperplasia two years earlier.

Rob Primhak MD FRCP MB BS Senior Lecturer and Honorary Consultant in Paediatrics, Children’s Hospital, Sheffield

As a paediatrician preparing the Comment for the autumn edition of RDIP, I was struck by the rather sparse paediatric content on this occasion, and sought to redress the balance by sharing one of the problems with which we are currently wrestling.

Jennifer A Pryor MSc MBA FNZSP MCSP Research Fellow Physiotherapy, Royal Brompton & Harefield NHS Trust

The patient with respiratory disease is usually well investigated and on optimal medical management, but could quality of life be further improved by referral for a physiotherapy assessment? Physiotherapy techniques may help by reducing the work of breathing, aiding mucociliary clearance, and increasing exercise capacity.

Tamara Shiner, Medical Student, Birmingham University Medical School; Robert J Shiner FRCPC Honorary Consultant, Respiratory Medicine, Hammersmith Hospital, London

The risk of any operation will depend on the type and site of the operation, the type of anaesthetic as well as the condition of the patient. The risk can be minimised by the use of local or epidural anaesthesia if appropriate.

Peter J Barnes MA DM DSc FRCP Professor of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London

Inhaled corticosteroids are now widely used in the treatment of chronic obstructive pulmonary disease (COPD) in the UK. This is often inappropriate and indeed patients may suffer from systemic side-effects.1

Peter Ormerod BSc MD FRCP Professor of Respiratory Medicine/Consultant General Physician, Blackburn Royal Infirmary and Chairman, Joint Tuberculosis Committee, British Thoracic Society

Drug resistance in tuberculosis has been around as long as the TB drugs themselves. After the introduction of streptomycin, isoniazid and para-amino-salicylic acid (PAS), it took several years to realise that spontaneous mutations allowed drug resistance to develop at an approximate rate of one in 107 organisms. Combination chemotherapy was needed to treat tuberculosis effectively, and to prevent the emergence of drug resistance. In 19601 over 10% of patients with tuberculosis and a history of prior treatment had drug resistance.