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Exacerbations of chronic obstructive pulmonary disease (COPD) are an important cause of morbidity and mortality in the condition, and their incidence increases with its severity. Some patients suffer frequent exacerbations leading to hospital admission, with considerable impact on their quality of life and activities of daily living. COPD exacerbations are associated with considerable physiological...
Two types of drug are used in the treatment of airway disease. • Relievers (bronchodilators) give immediate reversal of airway obstruction, largely by relaxing airway smooth muscle. • Controllers (preventers) suppress the underlying disease process and provide long-term control of symptoms. These drugs include anti-inflammatory treatments (Figure 1). Both asthma and chronic obstructive pulmonary...
Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality in the UK and worldwide. The association of COPD with the term 'irreversible airways disease' has led many doctors to the mistaken conclusion that it is 'untreatable'. Overcoming negative expectations is the first step in effective management. Acute respiratory failure in COPD is described in Respiratory...
Clinical diagnosis of asthma is usually based on an accurate history, supported by physical examination and confirmed by the demonstration reversible airflow obstruction on repeated measures of lung function.
Asthma is very common in children; in Western countries, it is the most common diagnosis in children admitted to hospital. Most surveys report that at least 10% of children have been diagnosed with asthma, and recent studies note that up to 40-50% of pre-school children have had recurrent wheeze over the preceding 12 months. There is now little doubt that the prevalence of asthma has increased worldwide...
Chronic obstructive pulmonary disease (COPD) is a general term encompassing several previously used clinical labels such as ‘chronic bronchitis and emphysema’, 'chronic obstructive airways disease' and 'chronic obstructive lung disease'. COPD is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as 'a disease state characterised by airflow limitation that is not fully reversible...
Despite major improvements in the recognition of patients with asthma and their treatment, both chronically and for acute episodes, acute severe asthma remains a life-threatening condition. Most patients who die from asthma have a history of chronic, often severe disease, but fatal or near-fatal events can occur in patients who have previously exhibited only mild or moderate symptoms. A background...
Asthma is a syndrome of variable airflow obstruction. It is characterized pathologically by bronchial inflammation with prominent eosinophil infiltration, physiologically by bronchial hyper-reactivity, and clinically by variable cough, chest tightness and wheeze. The prevalence of asthma varies geographically; it is particularly common in developed countries, where 10% of children and young adults...
Airways disease remains important in the workload of hospital respiratory physicians, and the respiratory workload of family doctors. Much research on asthma and chronic obstructive pulmonary disease (COPD) involves basic pathophysiology, including genetics, but this article deals with advances of importance to non-specialists, both now and in the future.
Respiratory illnesses resulting in hospital admission are common in children. The smaller airways of children are easily obstructed by inflammatory oedema and secretions. The marked chest wall re-cession seen with airways obstruction reflects the high compliance of their chest wall. When combined with their immature respiratory muscles, this can rapidly lead to respiratory failure.
Wheeze is a symptom and not a diagnosis. It is extremely common in infancy; 20-30% of children have experienced recurrent episodic wheezing by the age of 12 months. Wheezing may result from widespread peripheral airway narrowing or, less commonly, from localized central disease. Excluding recurrent viral wheezing and asthma-like symptoms, all other specific causes of wheezing (e.g. cystic fibrosis,...
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