Respiratory Topic Homepage
Respiratory Overview
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Respiratory medicine is the medical specialty that focuses on the study of the respiratory system, and on the diagnosis and the treatment of diseases of the lungs and bronchi.
In Europe, and worldwide, respiratory diseases are a leading cause of morbidity and mortality.1 Overall, in terms of incidence, prevalence, cost and mortality, they are placed second, behind cardiovascular disease.1 In 2003, the total financial cost of lung disease in Europe was estimated at 102 billion Euros.1 The most common respiratory diseases are; lung cancer, chronic obstructive pulmonary disease (COPD), asthma,...
... pneumonia, and tuberculosis.1
Asthma and COPD are the most common chronic respiratory diseases in adults in Europe.2 COPD is a set of chronic respiratory diseases affecting bronchial tubes, characterised by persistent obstruction of the airways, and accompanied by emphysema and/or chronic bronchitis.3 The prevalence of COPD is steadily rising worldwide due to the increased consumption of tobacco and an aging population.4
In 90% of cases, smoking is responsible for the development of respiratory diseases and thus represents the main risk factor.2 However, other factors appear to be involved but are insufficiently evaluated. These include; domestic and atmospheric pollution5, dietary habits6 and the level of physical activity.7 Studies are needed to understand the mechanisms involved, identify risk factors and genetic predisposition, and to develop new strategies for prevention and treatment of respiratory diseases, as in the case of COPD.8
1. European Respiratory Society. European lung white book. ERSJ Ltd, 2003 : 182 pages.
2. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. WHO Press. 2007 : available online.
3. Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003, 281-285.
4. Halbert R. J. et al. Global burden of COPD: systematic review and meta-analysis. European Respiratory Journal. March 2006 ; 28 : 523-532.
5. Schikowski T. et al. Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respiratory Research. December 2005 ; 6 : 152.
6. Hu G. et al. Antioxidant nutrients and pulmonary function: The third national health and nutrition examination survey (NHANES III). American Journal of Epidemiology. 2000 ; 151 (10) : 975-981.
7. Garcia-Aymerich J. et al. Physical activity and clinical and functional status in COPD. Chest. March 2009 ; 136 : 62-70.
8. Calverley P.M. et al. Chronic obstructive pulmonary disease. Lancet. September 2003 ; 362 (9389) : 1053-61.
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COPD
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease of the respiratory system resulting in decreased lung function, which is a growing cause of morbidity and mortality worldwide. It has been estimated by The WHO Global Burden of Disease project that COPD was the fourth leading cause of death in 2004 and predicts that by 2030 it will be the third.1 However it is thought that the current prevalence is an underestimate, due to a lack of awareness among primary care physicians.
The three main symptoms of COPD are dyspnoea (breathlessness), cough and sputum production.2 In addition to these symptoms, many patients also experience mild to moderate pulmonary hypertension, cor pulmonale, weight loss and a general deterioration in their feeling of well-being.3-5
Diagnosis of COPD can be made using a combination of different methods; patient history, physical examination, airflow measurements, chest X-ray, and electrocardiogram.2
This progressive disease has no cure; however treatments for COPD are widely used to reduce the symptoms. Treatment guidelines outline the available treatments for specific stages of COPD.2
Enter the COPD Knowledge Centre
References:
1. WHO The global burden of disease: 2004 update. Part 2 – Causes of death. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf (Accessed 11 November 2011).
2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2010). Available at: http://www.goldcopd.com/ - (accessed 11 November 2011).
3. Rennard S, Decramer M, Caverley PMA et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799-805.
4. Kumar P and Clark M (Eds.) Chapter 13 – Cardiovascular disease. In: Clinical Medicine 6th ed. Philadelphia, PA: Elsevier Saunders, 2005.
5. Agustí A. Systemic effects of chronic obstructive pulmonary disease – what we know and what we don't know (but should). Proc Am Thorac Soc 2007; 4: 522-525.
Cystic Fibrosis
Cystic Fibrosis (CF) is caused by a defect in a gene known as the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This gene makes a protein that controls the movement of ions, such as chloride, and water, across cell membranes.1,2
CF is caused by hundreds of different gene mutations. The most common mutation is delta F508, usually written as ΔF508.3
Thick, sticky mucus causes most of the symptoms of CF. The most common symptoms of CF include:4
- Persistent cough, often with phlegm
- Frequent lung infections
- Wheezing or shortness of breath
- Very salty-tasting skin
- Poor growth or weight gain despite a good appetite
- Greasy, bulky, foul-smelling stools Stomach pain and discomfort caused by too much gas in the intestines
- Dehydration
Because CF is a multisystem disease, treatment must be multidisciplinary, with a team of healthcare professionals providing comprehensive management of the patient.
Current therapy for CF is targeted at prevention and treatment of exacerbations. Care at the CF center includes inpatient as well as outpatient clinical care.5
Enter the Cystic Fibrosis Knowledge Centre
References
1. Boucher RC. Cystic Fibrosis. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al., editors. Harrison's Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 1-9.
2. Aitken M, Fiel SB, Stern RC. Cystic Fibrosis: Respiratory Manifestations. In: Taussig LM, Landau LI, editors. Pediatric Respiratory Medicine. 1st ed. St. Louis: Mosby, Inc.; 1999. p. 1-47.
3. Farrell PM, Kosorok MR, Rock MJ, et al. Early diagnosis of cystic fibrosis through neonatal screening prevents severe malnutrition and improves long-term growth. PEDIATRICS 2001;107:1-13.
4. National Heart Lung and Blood Institute. What Is Cystic Fibrosis. US Department of Health and Human Services National institute of Health 2005;1.
5. Smyth RL. Diagnosis and management of cystic fibrosis. Arch Dis Child Ed Pract 2005;90:1-6.
Clinical Case Studies
Sarcoidosis (Radiographic Stage I)
Respiratory Medicine & Allergy: Non granuloma interstitial lung diseaseSarcoidosis (Radiographic Stage I)
Anne Collett, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Richard Leach, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Case History
A 35-year-old male Caucasian barrister presented with a four-week history of dry cough, breathlessness and fatigue. There was no past medical history.
Hospital-acquired Pneumonia
Respiratory Medicine & Allergy: InfectionRichard Leach, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Case History
A 69-year-old man was admitted to hospital with acute abdominal pain and peritonitis. He had a history of indigestion but no previous cardiorespiratory illness.
Drug News
Phase III study of Tomtovok (Boehringer) meets endpoint for NSCLC
18-05-2013The LUX-Lung 6 randomized, open-label Phase III trial comparing Tomtovok (afatinib), from Boehringer, to standard chemotherapy in 364 Asian patients with Non Small Cell Lung Cancer has met its primary endpoint. Within the study population, patients treated with afatinib (n=242) lived for a median of 11.0 months before their tumor started to grow again versus 5.6 months for patients treated with...
IDMC halts Phase III study of Vargatef (Boehringer) in NSCLC
18-05-2013The LUME-LUNG 2 double-blinded Phase III study evaluating Vargatef (nintedanib), from Boehringer, plus pemetrexed compared to pemetrexed plus placebo in patients with advanced non-squamous NSCLC has been halted at the recommendation of the Independent Data Monitoring Committee after 713 patients had been enrolled. This decision was based on the results of an interim review of efficacy (PFS) for...
FDA approves Tarceva (Genentech/Astellas) for NSCLC as detected by cobas EGFR Mutation Test
16-05-2013
Genentech, and Astellas Pharma US, Inc. have announced that the FDA has approved Tarceva (erlotinib) tablets for the initial (first-line) treatment of people with metastatic Non-Small Cell Lung Cancer (NSCLC) whose tumors have certain epidermal growth factor receptor (EGFR) activating mutations as detected by an FDA-approved test.
The FDA also approved the cobas EGFR Mutation Test,...
Respiratory Drug Data - A-Z
Possible searches include drugs or medicines (by brand, generic ingredient or drug class), diseases, conditions and more.
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Recent Drug Updates
Seebri Breezhaler Inhalation Powder, Hard Capsules 44mcg
06-03-2013Seebri Breezhaler is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD)....
Esbriet 267 mg hard capsules
29-01-2013Esbriet is indicated in adults for the treatment of mild to moderate Idiopathic Pulmonary Fibrosis (IPF)....
Curosurf
03-12-2012For the treatment of Respiratory Distress Syndrome (RDS) or hyaline membrane disease in newborn babies with birth weight over 700g. Prophylactic use in premature infants between 24 and 31 weeks...
Clinical Guidelines
Mannitol dry powder for inhalation for treating cystic fibrosis
Nov 2012Mannitol (Bronchitol, Pharmaxis) is a mucoactive agent that causes water to enter the airway lumen..
... and hydrate airway secretions. This reduces the viscosity of
secretions and stimulates cough, thereby increasing the clearance of secretions and pathogenic bacteria. Mannitol dry powder is inhaled from a hand-held, breathactivated device.
Guidelines for the management of work-related asthma
Mar 2012Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one..
... of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder.
Online CME
Clinical Review - COPD
Apr 2013
... severity of the disease and how to manage exacerbations.
Clinical Review - Asthma in children
Apr 2013
... asthma; how to manage and when to refer.
Clinical Trials
Non-invasive Diagnostics of Pulmonary Hypertension With Dual Energy Computed Tomography
09-04-2013The aim of the study is to determine relevant hemodynamic parameters for the diagnostics of pulmonary arterial hypertension (PAH) by dynamic contrast enhanced dual-energy CT (DE-CT). In this prospective study the investigators validate DE-CT results of patients against hemodynamic parameters from right heart..
... catheterisation and control the results by other clinical investigations. The investigators expect that using this non-invasive method, parameters relevant for the diagnosis of the patients with PAH, like pulmonary blood volume, blood flow and perfusion heterogeneity, can be determined.
Physiotherapy in Exacerbation Chronic Obstructive Pulmonary Disease
28-03-2013Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition. Its evolution can be aggravated in some periods by an increase of the symptoms (above all the cough, the dyspnoea and the quantity of sputum purulence). This is known as exacerbation and it is the most frequent cause of hospital stay, urgences..
... services and death in COPD. A physiotherapy program is carrying out in patients attending to the Hospital because of an exacerbation.
The hypothesis of this study is that a physiotherapy program added to a medical treatment increase the ventilatory function, the physiques variables, decrease depression and anxiety and improve the quality of life. Additionally, it is going to be assessed the effect of physiotherapy in time using phone calls and visits to the patient's home.
Medical Videos
Medical Journal Abstracts
Safety and efficacy of paclitaxel liposome for elderly patients with advanced non-small cell lung cancer: A multi-center prospective study
Thoracic Cancer
Feb 2013
Background: Lung cancer in elderly patients poses an increasingly challenge for oncologists. The optimal treatment needs to be explored. The purpose of this study was to evaluate the safety and efficacy of the novel form of paclitaxel liposome for elderly patients with non-small cell lung cancer (NSCLC). Methods: This..
Angiopoietin 2 levels in serum and bronchial lavage fluids and their relationship with cancer stages in lung cancer patients
Thoracic Cancer
Feb 2013
Background: An elastofibroma is a benign, soft-tissue tumor and is important in the differential diagnosis of thoracic wall masses. Here, patients with elastofibromas who underwent thoracic surgery were retrospectively reviewed to elucidate elastofibroma formation and to facilitate the differential diagnosis. Methods:..
Medical Apps
Blausen Respiratory Atlas - £2.99
Asthma Info - Free
The animated pocket dictionary of respiratory diseases - Free
COPD diary card - Free
Social Media
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‘The Good Patient Syndrome’ - a real phenomenon?
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