Journal Mobile

JJ Miller
Journal Issue: 
Volume 39: Issue 2: 2009




This respiratory symposium focused on pleural disease, allergy and the new guidelines for oxygen delivery.
The management of pleural disease is changing, partly due to safety concerns. For example, safer designs of the Seldinger drain are being  developed  and  chest  ultrasound  is  now  recommended  prior  to  siting  an intercostal  drain.  Greater  availability  of  medical  and  surgical  thoracoscopy  means there is less use of the Abrams pleural biopsy, although this has implications for the organisation and provision of services. British Thoracic Society guidelines advocate that  doctors  now  prescribe  oxygen  including  the  mode  of  delivery  and  target oxygen  saturations.  The  incidence  and  epidemiology  of  allergic  conditions  was presented. The  incidence  of  allergic  disease  is  rising  and  lifestyle  factors  such  as exercise  and  obesity  may  be  implicated. The  remaining  presentations  focused  on respiratory disease in relation to driving, osteoporosis and liver disease. Doctors have a role in alerting patients to the legal implications of their medical condition with respect to driving. Obstructive sleep apnoea/hypopnoea syndrome is increasing in incidence; it is a treatable condition but has implications for driving if untreated. Inhaled  and  oral  corticosteroids  use  results  in  bone  demineralisation  and osteoporosis, which in turn results in increased fracture risk. Bisphosphonates are indicated  for  steroid-induced  osteoporosis,  and  as  this  develops  most  rapidly  on initiation of corticosteroid, bone protection should be considered when therapy is commenced. The symposium ended with a presentation of the two pathologically distinct vascular syndromes linking pulmonary and hepatic disease. Hepatopulmonary syndrome is associated with pulmonary venous dilatation, and can be treated with liver  transplant,  whereas  porto-pulmonary  hypertension  is  associated  with pulmonary venous constriction and may respond to vasodilators.