Chronic Respiratory Disease

Background: The purpose of this study is to compare emotional and behavioural problems between preadolescent children with asthma and healthy children, and to explore if disease factors relate to problem scores. Design: This was a cross-sectional study of 59 children, 34 boys and 25 girls, aged 7-9 years with mild (n = 11), moderate (n = 38) or severe (n = 10) asthma. A normative sample of 306 children in the same age range, 150 boys and 156 girls, was used as a comparison group.Methods: Parents assessed emotional and behavioural problems using the Child Behaviour Checklist. Peak expiratory flow rate and urinary eosinophil protein X were used as measures of lung function and inflammation. Children were interviewed about activity restriction and symptoms during the last week using the Paediatric Asthma Quality of Life Questionnaire. Parents scored day,night and exercise-induced symptoms during the same week. Results: On average, children with asthma were attributed more problems than healthy children of the same age and comparable family socio-economic status. Effect sizes were 0.80 (95% confidence interval 0.52-1.09) for total problems, 0.89 (0.60-1.18) for internalizing problems and 0.67 (0.38-0.95) for externalizing problems. The relative risk for children with asthma exceeding the 95% cut-offpoint for total problems was 4.2 (2.1-8.3) compared to healthy children. Conclusion: Children with parent-reported exercise-induced asthma symptoms were attributed more total problems than asthmatic children without such symptoms. Parent-reported day symptoms and child report of symptoms and restricted activities related with problem scores to a lesser degree. Objective measures of lung function and inflammation were not related to problem scores. Concurrent eczema increased problem scores. It is concluded that asthma in preadolescent children is associated with emotional and behavioural problems. Special attention should be paid to children reported to have exercise-induced symptoms.

Introduction: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent reason for admission to hospital and are responsible for the majority of the direct economic costs of treating COPD. Aims: To test whether an individualized care plan for patients experiencing acute exacerbations of COPD result in reduced health care utilization and improved quality of life for patients. Methods: Ninety-two patients with confirmed COPD were selected by general practitioners or district nurses, and randomly assigned to care plan or usual care groups. The care plan was developed in collaboration with general practitioners, secondary care specialists, specialist nurses, ambulance service providers and the after hours clinic. Patients were followed for 12 months, and the primary end-points were frequency of use of primary care services and hospital admissions. Results: There was no significant reduction in hospital admissions or improvement in quality of life in the group of patients who used the care plan compared to controls. The care plan group called out the ambulance service more frequently [2.8 (1.3, 4.3) versus 1.1 (0.7, 1.5) calls per 12 months; P = 0.03], and there was a trend towards greater use of oral prednisone [2.3 (1.4, 3.2) versus 1.3 (0.8, 1.8) courses per 12 months; P = 0.06]. Conclusion: In contrast to asthma, the provision of individualized self-management plans, whose content was enhanced to provide guidance to carers and health care professionals, did not reduce health care utilization or improve overall quality of life during acute exacerbations of COPD. Other strategies are required.

Study objectives: Some subjects with COPD have an elevated resting energy expenditure (REE)which may be related to an increased work of breathing at rest. The purpose of this study was to examine the effect of lung volume reduction surgery (LVRS) on REE and body weight. Design: Ten subjects with COPD were recruited (mean age + SD = 61.4 + 6.1 years). At baseline (which was following preoperative pulmonary rehabilitation) and four months following LVRS (combined with postoperative pulmonary rehabilitation), each subject had tests of lung function, REE via indirect calorimetry using a canopy system, six minute walk distance (6MWD) and quality of life (QoL) using the St George's Hospital Respiratory Questionnaire (SGRQ). Measurements: The FEV, (% predicted) increased from 27.7 + 5.8% (mean + SD) at baseline to 33.9 + 7.8% following LVRS (P < 0.05). REE (% predicted) was 110 + 9.8% at baseline and decreased to 106 + 6.7% following LVRS (P = 0.04). Body mass index (BMI) following LVRS was unchanged (P = 0.67). No correlation between the change in BMI and change in REE was shown (r² = 0.3, P = 0.1). Therewas a significant improvement in QoL following LVRS (P < 0.001). 6MWD also significantly increased from 354 + 83 m to 412 + 82 m following LVRS (P = 0.001). Conclusion: Whilst there was an increase in lung function and a reduction in REE following LVRS, there was no corresponding change to body weight. The improvement in REE following LVRS may be related to an improvement in work of breathing.

Cystic fibrosis (CF) is a recessively inherited condition caused by mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Characterization of the genetic defect has improved understanding of the condition and, in the majority of cases, diagnosis is straightforward. However, in a significant number, diagnosis remains a challenge. This paper will discuss the management of these issues and reflect on atypical presentations. In addition we will discuss situations in which genetic variations of the CFTR gene are not associated with a classical CF phenotype and the implications for practice in both paediatric and adult clinics.

A considerable amount of literature has described the prevalence of anxiety in patients with the lung condition chronic obstructive pulmonary disease (COPD). Few, if any, papers have reviewed the inter-relationship between anxiety symptoms and self-management interventions in this population. This is the aim of the current review. First, the review examines the evidence suggesting that anxiety is more common in COPD than other populations. Secondly, the focus shifts to evaluating the evidence for and against the efficacy of COPD self-management programmes. Finally this paper examines the relationship between anxiety and COPD self-management with particular reference to the benefits and possible harm of some COPD self-management goals and anxious patients.

When dealing with smokers it is important to realize that nicotine addiction plays a major role. Minimal clinic smoking cessation advice by a physician is a powerful motivation to quit and even short intervention (<3 minutes) is effective especially when repeated. There is a dose-response relationship between the number and duration of sessions and quit rate. The optimum programme contains 4-5 sessions of 10-15 minutes duration during the first six weeks after quit day. It is essential that smokers select a target quit day and stop smoking completely on that day as even a few cigarettes per day in the first weeks are strongly related to relapse. Administration of nicotine replacement products or bupropion may double success rates. The communication with smokers should be emphatic and adjusted to the level of change. Barriers to successful smoking cessation and structured interventions are described. The use of the five As to motivated smokers and the five Rs to smokers not ready to quit is recommended. Telephone and written material may supplement clinic visits in the follow-up period.

We report here an unusual case of a 25-year old male with juvenile onset recurrent respiratory papillomatosis who developed an infestation of papillomata ‘papillomatization’ of an old abscess cavity that, when removed, was coincidently found to contain a 2 cm well differentiated squamous cell carcinoma. The abscess cavity had been caused by a previous Fusobaterium necrophorum infection that probably developed as a result of septic emboli from his internal jugular veins. This once common but now rare occurrence was first reported by Dr Lemierre in 1936 (Lemierre syndrome).