Volume 19, Number 1

Justin CT Pepperell MRCP DA Research Registrar; Robert Davies FRCP DM Consultant Physician, Osler Chest Unit, Churchill Hospital, Oxford

This article discusses the relationship between arterial blood pressure (BP) and obstructive sleep apnoea (OSA). It will briefly discuss the epidemiology of BP and cardiovascular risk with some of the confounders through which a relationship with OSA may be obscured.

Philip Ind, Editor

The latest issue of Thorax includes a supplement containing the new, evidence-based British guideline on the management of asthma from the British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN). It is the fourth in a series of influential guidelines which began 12 years ago with the publication of two papers in the BMJ (which were subsequently rewritten in 1993 and updated in 1995). So what is new about the latest version?

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

It has proved extraordinarily difficult to develop new classes of drug for the treatment of asthma and most new treatments have been improvements of existing classes of drugs, such as corticosteroids and b2-agonists. Furthermore, existing treatments for asthma are highly effective if used correctly, so that there is little room for improvement in the management of the majority of patients. However, several new treatments are currently in development for asthma therapy.1

Jonathan I Ferguson FRCS Specialist Registrar in Cardiothoracic Surgery, Papworth Hospital, Cambridge; William S Walker FRCS Consultant Surgeon, Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh

Patients with non-small cell lung cancer (NSCLC) and known neoplastic deposits in mediastinal lymph nodes before surgery repeatedly show very poor long-term prognoses, even if extensive pulmonary resection is performed.1–3 Furthermore, in these patients, perioperative mortality actually exceeds survival.2 In the absence of distant metastases, staging the mediastinal lymph nodes determines which patients will potentially be cured by surgery.

L Peter Ormerod MD DSc(Med) FRCP Consultant Physician, Blackburn Royal Infirmary, Professor of Medicine, Postgraduate School of Medicine and Health, University of Central Lancashire

Opportunist mycobacteria are widely distributed in nature and the number of isolates of such organisms is increasing in HIV-negative as well as HIV-positive individuals.1 There can be difficulties in making the diagnosis, in differentiating opportunist infection from tuberculosis, in deciding whether there is true infection or merely contamination, and in clinical management.

Philip Ind FRCP Senior Lecturer and Honorary Consultant Physician, Hammersmith Hospital, London

Inhaled corticosteroids are the cornerstone of asthma therapy and are likely to remain so over the next ten years. They have a very broad spectrum of anti-inflammatory effects and clinical benefits in persistent asthma of all grades of severity (Table 1). They are also generally well tolerated and safe. Local side-effects include sore throat, thrush, and hoarseness, but these are usually relatively easily dealt with.

Robina K Coker MRCP(UK) PhD Senior Lecturer & Honorary Consultant in Respiratory Medicine, Imperial College Faculty of Medicine, Hammersmith Hospital, London. (1999–2001 Chair of the British Thoracic Society Working Party on Air Travel and Respiratory Disease)

In the last 50 years air travel has become increasingly popular. In 1995, 1,285 million passengers flew on commercial flights worldwide; this number has been predicted to exceed 2,000 million by 2005. In-flight medical emergencies have recently attracted much attention from the media, travelling public and aviation industry.