Volume 18, Number 1

Warren Lenney MD FRCP FRCPCH DCH Consultant Respiratory Paediatrician, Academic Dept of Child Health, North Staffordshire Royal Infirmary, Stoke-on-Trent

In 1955, investigators in the USA cultured a new virus from nasal secretions in young chimpanzees with severe coryzal symptoms. They named it the chimpanzee coryza agent (CAA).1 In the following year CAA-like viruses were recovered from two children with severe respiratory illnesses in Baltimore.2

Stephen Iles MRCP BSc(Hons) Medical Registrar; Christopher Swinburn MD FRCP Consultant Physician, Taunton & Somerset NHS Trust, Musgrove Park, Taunton

Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality. Many patients have moderate to severe disease at presentation. Bronchodilators remain the mainstay of treatment therapy. Which drugs to use, in what dose and by which means of delivery, are important choices to make for each patient. With the growing use of spirometers in primary care, these questions can be logically addressed in accordance with recent guidelines.1

Jonathan I Ferguson FRCS Senior House Officer; William S Walker FRCS Consultant Surgeon, Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh

Historically, rigid bronchoscopy was the only method of directly visualising the endobronchial tree and of operating or biopsing endoluminally. Flexible fibreoptic bronchoscopy has revolutionised the diagnosis and management of pulmonary diseases. Although the vast majority of endoscopic procedures are now performed with flexible bronchoscopes, there is still a well defined role for rigid bronchoscopy.

Robert G Stirling MRCPI FRACP; Kian Fan Chung MD FRCP Royal Brompton & Harefield Hospital and National Heart & Lung Institute, London

Cough is a reflex and volitional protective mechanism of the upper airways causing expulsion of air at high velocity, enabling fluid and particulates to be dislodged and expelled from upper and lower airways. However, many conditions can accentuate the cough reflex, leading to persistence of this symptom – which is among the most common causes for presentation to the general practitioner.1–4

Fiona Hicks BmedSci FRCP Consultant in Palliative Medicine, Leeds Teaching Hospitals NHS Trust

Dyspnoea, defined as an uncomfortable awareness of breathing, is a common symptom in end-stage respiratory disease.1 As a subjective sensation, dyspnoea often has physical, psychological, social and spiritual dimensions which form the patient’s experience, akin to the concept of ‘total pain’ coined by Cicely Saunders in the early days of the hospice movement.

Philip Ind, Editor

All GPs write referral letters and all consultants write replies (and referrals to other specialists). These letters represent day-to-day but important interactions that guide the crucial steps between the first patient contact and access to scarce, expensive and worrying (to the patient) hospital care.