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.
