Volume 18, Number 2

William Egner, Consultant Immunologist, Sheffield Teaching Hospitals Trust, Northern General Hospital, Sheffield

Anaphylaxis is the most severe form of allergic reaction, often resulting in life-threatening dyspnoea or hypotension. It was initially described in 1901 by Porter and Richet, as the opposite of the prophylaxis induced by repeated vaccination; in this case after repeated immunisation, severe reactions occurred.

Christopher Bass MA MD FRCPsych Consultant in Liaison Psychiatry, Department of Psychological Medicine, John Radcliffe Hospital, Oxford

Primary care doctors and chest physicians have always dealt with large numbers of patients in their clinics who report symptoms of breathlessness which are out of proportion to the organic findings. Different terms have been proposed for these patients, including ‘hyperventilation syndrome’,1 ‘unexplained breathing disorder’2 and ‘behavioural breathlessness’.3

Philip Ind, Editor

We have a new government. We also have a new set of promises on delivery of healthcare. On top of national targets for cancer, heart disease and mental health come the National Service Frameworks (NSFs) for renal disease, care of older people and children’s health.

Mark Everard MB ChB FRCPCH DM Consultant in Paediatric Respiratory Medicine, Sheffield Children’s Hospital; Nicolas Cobos MD Head of Section Paediatric Department

Aerosol therapy has been used for hundreds of years to treat a variety of pulmonary diseases such as asthma,1 COPD and cystic fibrosis. Aerosol therapy was used initially because the speed of onset of drugs such as anticholinergics and beta2-agonists is much greater when inhaled as compared with oral therapy.2 In addition, the inhaled route confers benefits in terms of the therapeutic index for drugs such as beta2-agonists, inhaled corticosteroids3 and aminoglycoside antibiotics.

Stephen Connellan FRCP Consultant Respiratory Physician, Royal Wolverhampton NHS Hospitals Trust and Honorary Senior Lecturer, Wolverhampton University

Many years ago, a recreational drug, packaged in a handy inhaler device, was introduced to this country. Initially used by adult males, it subsequently also became popular with females. Its use became socially accepted and widespread; but unfortunately, clear evidence came to light that the packaging caused or contributed to several types of cancer, heart attacks, arterial damage and blockage, bronchitis and emphysema and many other health hazards which may also affect bystanders who are not followers of the habit.

JAC Thorpe FRCS FETCS Consultant Thoracic Surgeon Leeds General Infirmary

In recent times thoracic surgeons have focused on exploring minimally invasive surgical techniques. There are now several different approaches to the thoracic cavity and the mediastinum, for example muscle-sparing thoracotomy and video-assisted thoracic surgery (VATS). Post-thoracotomy pain was a common problem in traditional posterolateral thoracotomy, occurring in up to 25% of patients. This problem had spurred surgeons on to develop more minimally invasive techniques.

Ian Sutcliffe MRCP MBBS Specialist Registrar in Respiratory and General Medicine, Bradford Royal Infirmary; Mark W Elliott MD FRCP Consultant Respiratory Physician, St James’s University Hospital, Leeds

The need for invasive mechanical ventilatory support is the most common reason for admiss-ion to intensive care units (ICUs), and can arise as a result of a diverse range of disease states that, either directly or indirectly, cause acute respiratory failure.1 In some cases, ventilatory support can be withdrawn rapidly once the original insult has been reversed. In other circumstances, ‘weaning’ from ventilatory support can be difficult and time consuming, and the outcome can be unpredictable.2