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1
Seminar cum Workshop on "Chronic Sinusitis & Other Respiratory Tract Infections" (2007 Shillong, India). Proceedings of Seminar cum Workshop on "Chronic Sinusitis & Other Respiratory Tract Infections": 23rd & 24th March, 2007, venue All Saints Cathedral Hall, Shillong. New Delhi: Central Council for Research in Homoeopathy, 2007.
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Seminar, cum Workshop on "Chronic Sinusitis &. Other Respiratory Tract Infections" (2007 Shillong India). Proceedings of Seminar cum Workshop on "Chronic Sinusitis & Other Respiratory Tract Infections": 23rd & 24th March, 2007, venue All Saints Cathedral Hall, Shillong. New Delhi: Central Council for Research in Homoeopathy, 2007.
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3
American College of Physicians (2003- ). Clinical practice: American College of Physicians guidelines and U.S. Preventive Service Task Force recommendations. Edited by Snow Vincenza 1961- and U.S. Preventive Services Task Force. Philadelphia: American College of Physicians, 2005.
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Kulkarni, Kunal, James Harrison, Mohamed Baguneid, and Bernard Prendergast, eds. Respiratory medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198729426.003.0017.
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Respiratory medicine is a diverse specialty involving common chronic diseases, rarer conditions, pulmonary involvement in systemic disorders, lung infections, tumours, and adverse drug effects. It is also an important component of general internal medicine. Respiratory medicine has been prominent in producing clinical guidelines, many of which are now evidence-based, and hence a good source of information and reference. Some of the commonest medical conditions, including asthma and lung cancer, are rooted in respiratory medicine. Although declining, lag effects mean these conditions are increasingly prevalent and continue to be important, particularly in the developing world. Sleep medicine is now also beginning to receive attention, and respiratory infections remain common. Respiratory research is broad-based, but the level of government and major charity funding is low. This chapter summarizes important recent clinical papers under the subheadings of asthma, chronic obstructive pulmonary disease, infection, lung cancer, and smoking, with contributions from pulmonary vascular disease and sleep.
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Sibilano, Helena. EFFECT OF UPPER RESPIRATORY INFECTION ON RESPIRATORY MUSCLE STRENGTH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. 1994.
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Millar, Professor Ann B., Dr Richard Leach, Dr Rebecca Preston, Dr Richard Leach, Dr Richard Leach, Dr Wei Shen Lim, Dr Richard Leach, et al. Respiratory diseases and respiratory failure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199565979.003.0005.
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Chapter 5 covers respiratory diseases and respiratory failure, including clinical presentations of respiratory disease, assessment of diffuse lung disease, hypoxaemia, respiratory failure, and oxygen therapy, pneumonia, mycobacterial infection, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, mediastinal lesions, pneumothorax, pleural disease, asbestos-related lung disease, diffuse parenchymal (interstitial) lung disease, sarcoidosis, pulmonary hypertension, acute respiratory distress syndrome, bronchiectasis and cystic fibrosis, bronchiolitis, eosinophilic lung disease, airways obstruction, aspiration syndromes, and near-drowning, pulmonary vasculitis, the immunocompromised host, sleep apnoea, and rare pulmonary diseases.
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Gilchrist, Francis J., and Alex Horsley. Management of respiratory exacerbations. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0005.
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Cystic fibrosis lung disease is characterized by chronic infection, inflammation and a progressive loss of lung function. Patients are also affected by recurrent episodes of increased respiratory symptoms, called exacerbations which have a detrimental effect on quality of life, the rate of lung function decline, and mortality. Early diagnosis and treatment is vital. Diagnosis relies on a combination of symptoms, examination findings, the results of laboratory tests, and lung function. Antibiotics are the mainstay of treatment but airway clearance, nutrition, and glucose homeostasis must also be optimized. Mild exacerbations are usually treated with oral antibiotics and more severe exacerbations with intravenous antibiotics. The choice of antibiotic is guided by the patient’s chronic pulmonary infections, the in-vitro antibiotic sensitivities, known antibiotic allergies, and the previous response to treatment. In patients with chronic Pseudomonas aeruginosa infection, antibiotic monotherapy is thought to increase the risk of resistance and treatment with 2 antibiotics is therefore suggested (usually a β-lactam and an aminoglycoside). Although there is a lack of evidence on the duration of treatment, most patients receive around 14 days. This can be altered according to the time taken for symptoms and lung function to return to pre-exacerbation levels. If patients are carefully selected and receive appropriate monitoring, home intravenous antibiotics can be as effective as in-patient treatment. They are also associated with decreased disruption to patients / family life, decreased risk of cross infection and decreased costs.
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Cooke, Graham. Viral infection. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0308.
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Viral infection includes any clinical illness caused by a pathogenic virus. Acute viral infections are amongst the most common illnesses of humans and range from minor upper respiratory tract infections to viral haemorrhagic fever. The principles in diagnosing acute viral infection are, first, recognize the syndrome, then identify key features that might suggest a specific diagnosis, and, finally, consider laboratory investigations to elucidate the specific causative agent. The host–pathogen response determines different outcomes for specific viral infections. After infection with some viruses (e.g. measles virus, rubella virus) protective immunity develops, there is no latency or chronic carriage, and reinfection is prevented. Another group of viruses, in the presence of inadequate immune response, can cause chronic infection (e.g. hepatitis B and C viruses). This chapter reviews the clinical features, diagnosis, and management of acute viral infections in immunocompetent individuals.
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Herbert, Lara, and Bruce McCormick. Respiratory disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719410.003.0005.
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This chapter describes the anaesthetic management of the patient with respiratory disease. It describes the assessment of respiratory function and preoperative respiratory investigations, and ventilatory strategies to reduce pulmonary complications. Common respiratory conditions covered include respiratory tract infection, smoking, asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea, sarcoidosis, restrictive pulmonary disease, and the patient with a transplanted lung. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. Recommendations for the patient who may require post-operative respiratory support (e.g. non-invasive ventilation) are provided.
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Herbert, Lara, and Bruce McCormick. Respiratory disease. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0005_update_001.
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This chapter describes the anaesthetic management of the patient with respiratory disease. It describes the assessment of respiratory function and preoperative respiratory investigations, and ventilatory strategies to reduce pulmonary complications. Common respiratory conditions covered include respiratory tract infection, smoking, asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea, sarcoidosis, restrictive pulmonary disease, and the patient with a transplanted lung. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. Recommendations for the patient who may require post-operative respiratory support (e.g. non-invasive ventilation) are provided.
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Kosmidis, Chris, David W. Denning, and Eavan G. Muldoon. Fungal disease in cystic fibrosis and chronic respiratory disorders. Edited by Christopher C. Kibbler, Richard Barton, Neil A. R. Gow, Susan Howell, Donna M. MacCallum, and Rohini J. Manuel. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755388.003.0037.
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A range of fungal disease syndromes affect patients with chronic respiratory diseases and cystic fibrosis (CF). Invasive aspergillosis is increasingly recognized in seriously ill patients with chronic obstructive pulmonary disease, especially after high-dose steroids. Chronic pulmonary aspergillosis affects patients with pre-existing cavities or bullae, such as those with previous tuberculosis or atypical mycobacterial disease, bullous emphysema, sarcoidosis, pneumothorax, or treated lung cancer. In addition, fungi have become one of the most important trigger agents for asthma, and allergic bronchopulmonary aspergillosis may complicate up to 3.5% of cases of asthma and up to 15% of cases of CF, starting in childhood. CF patients are commonly colonized with fungal organisms, although the impact of such colonization on outcome is not clear. Aspergillus is the most common mould isolated from CF patients. Distinguishing between colonization and infection remains challenging. Candida is thought to be of no clinical significance; however, it has been associated with decline in lung function.
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Innes, J. Alastair. Respiratory complications and management of severe CF lung disease. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0006.
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This chapter covers the most common medical complications of severe CF lung disease, excluding the treatment of infection exacerbation. The section on haemoptysis covers severity assessment, medical and interventional radiological approaches to managing this problem. The particular risks of pneumothorax in CF are then discussed, including the factors guiding referral to surgery. The management of acute and chronic respiratory failure in CF is covered. This includes the indications for home oxygen and for non-invasive ventilation, and guidance on how these should be used in CF. Finally, there is a section on terminal care in cystic fibrosis, covering the management of the transition to palliative management at the end of life, and appropriate strategies to support patient and family in advanced disease.
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Lung Diseases: Chronic Respiratory Infections. MDPI, 2018. http://dx.doi.org/10.3390/books978-3-03897-339-3.
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Gardiner, Matthew D., and Neil R. Borley. Core surgical skills and knowledge. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199204755.003.0015.
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This chapter begins by discussing the basic principles of fluid and electrolyte homeostasis, fluid therapy, healthcare-associated infection, microorganisms and antimicrobials, preoperative assessment, and acute pain, before focusing on the key areas of knowledge, namely deep venous thrombosis, pulmonary embolism, respiratory tract infection, asthma, chronic obstructive pulmonary disease, acute respiratory failure, ischaemic heart disease, heart failure, cardiac arrhythmias, hypertension, diabetes mellitus, acute renal failure, stroke, acute confusional state, and haematological conditions. The chapter concludes with relevant case-based discussions.
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Thaisetthawatkul, Pariwat, and Eric Logigian. Guillain-Barré Syndrome and Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Pregnancy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0026.
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Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are both immune-mediated diseases of the peripheral nervous system that typically present with symmetric, progressive muscle weakness, areflexia, and sensory symptoms or signs. GBS evolves rapidly with a nadir at 2–4 weeks usually with an antecedent viral illness, while CIDP progresses more slowly over months to years. GBS is sometimes complicated by life-threatening respiratory failure or dysautonomia. Onset of GBS and relapse of CIDP can occur during pregnancy or postpartum. But with appropriate supportive care and immunotherapy, maternal and fetal outcome in both conditions is typically excellent. The exception is fetal outcome in GBS triggered by maternal CMV or Zika infection transmitted to the fetus. Full-term vaginal delivery and regional anesthesia are preferred in maternal GBS and CIDP, but if C-section and general anesthesia are indicated, non-depolarizing agents such as succinylcholine should be avoided.
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Govan, John, and Andrew Jones. Microbiology of CF lung disease. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0003.
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This chapter presents the microbiology of CF and describes the classical bacterial pathogens including Staphylococcus aureus, Haemophilus influenza, Pseudomonas aeruginosa and organisms of the Burkholderia cepacia complex. The dominant of these is P. aeruginosa. Infections with other opportunistic pathogens including non-tuberculous mycobacteria, Stenotrophomonas maltophila, and Achromobacter (Alcaligenes) xylosoxidans are also encountered. This chapter details measures to prevent the onset of chronic infection with these organisms include regular screening of respiratory tract samples for bacterial pathogens and the use of aggressive antibiotic therapy to eradicate initial infection before the pathogen can adapt to the environment of the CF lung. Patient-to-patient spread of transmissible strains of bacterial pathogens has led to the implementation of strict infection control measures at CF centres, including patient segregation. In addition to bacterial pathogens, the contribution of fungal infection in CF lung disease is increasingly recognized.
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Messacar, Kevin, and Mark J. Abzug. Enterovirus and Parechovirus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0003.
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Enteroviruses (EVs) comprise a genus in the Picornaviridae family. They are single-stranded RNA viruses and are common causes of human infection. Polioviruses, the prototypic EVs, were historically responsible for widespread outbreaks of paralytic poliomyelitis; now they are on the verge of global elimination through vaccination. More than 100 serotypes of nonpoliovirus EVs are described and are associated with a wide variety of diseases, ranging from respiratory infections, nonspecific febrile illnesses, herpangina, and hand-foot-and-mouth disease to meningitis, encephalitis, paralytic disease, myocarditis, chronic or disseminated infection in immunocompromised hosts (particularly those with defects in the humoral immune response), and severe disease in neonates. This chapter reviews disease manifestations during pregnancy and in neonates, with an emphasis on clinical presentation, diagnosis, and management. The newly emerging parechoviruses, important causes of central nervous system (CNS) disease, are also reviewed.
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Török, M. Estée, Fiona J. Cooke, and Ed Moran. Respiratory, head, and neck infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199671328.003.0014.
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This chapter covers the common cold, pharyngitis, retropharyngeal abscess, quinsy (peritonsillar abscess), Lemierre’s disease, croup, epiglottitis, bacterial tracheitis, laryngitis, sinusitis, mastoiditis, otitis externa, otitis media, dental infections, lateral pharyngeal abscess, acute bronchitis, chronic bronchitis, bronchiolitis, community-acquired pneumonia, aspiration pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, pulmonary infiltrates with eosinophilia, empyema, lung abscess, cystic fibrosis, bronchiectasis, and pulmonary tuberculosis.
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Jacquet, Gabrielle, and Andrea Dugas. Influenza. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0026.
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Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard precautions, and minimizing visitors for patients in isolation for influenza.
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Smith, Jacky. Cough. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0016.
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A cough is an explosive forced expiratory manoeuvre, usually against a closed glottis, and gives rise to a characteristic sound. Acute cough is defined as a cough of less than 3 weeks duration, and chronic cough as one of more than 8 weeks duration. Acute cough is the commonest presenting symptom in primary care: by far the most frequent cause is a viral respiratory tract infection. The main effect of coughing is on quality of life and this is particularly prominent in patients with chronic cough, as these frequently develop physical complications such as chest pain, retching and vomiting, hoarseness, incontinence, sleep disturbance, and syncope. In addition, psychological distress and social embarrassment are often features. This chapter covers the approach to diagnosis for acute and chronic cough as well as diagnostic tests, therapies, prognosis, and dealing with uncertainty.
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Jex, Aaron R., Rachel M. Chalmers, Huw V. Smith, Giovanni Widmer, Vincent McDonald, and Robin B. Gasser. Cryptosporidiosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0053.
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Cryptosporidium species represent a genus of parasitic protozoa (Apicomplexa) that are transmitted via the faecal-oral route and commonly infect the epithelial tissues of the gastric or intestinal (or sometimes the respiratory) tract of many vertebrates, including humans. Infection occurs following the ingestion of viable and resistant oocysts, through direct host-to-host contact or in contaminated food, drinking or recreational water. Infection can be transmitted via anthroponotic (human-to-human, human-to-animal) or zoonotic (animal-to-human or animal-to-animal) pathways, depending upon the species of Cryptosporidium. Although infection can be asymptomatic, common symptoms of disease (cryptosporidiosis) include diarrhoea, colic (abdominal pain), nausea or vomiting, dehydration and/or fever. In humans, cryptosporidial infection in immunocompetent patients is usually short-lived (days to weeks) and eliminated following the stimulation of an effective immune response. However, infection in immunodeficient individuals (e.g., those with HIV/AIDS) can be chronic and fatal (in the absence of immunotherapy), as there are few effective anti-cryptosporidial drugs and no vaccines available. The present chapter provides an account of the history, taxonomy and biology, genomics and genetics of Cryptosporidium, the epidemiology, pathogenesis, treatment and control of cryptosporidiosis and the advances in tools for the identification and characterisation of Cryptosporidium species and the diagnosis of cryptosporidiosis.
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O’Riordan, Stephen MP, and Antoinette Moran. Cystic fibrosis-related diabetes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0008.
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This chapter on CFRD reviews the ever-evolving topic and provides up-to-date information on how to diagnose and manage cystic fibrosis-related diabetes CFRD in the acute and chronic setting. The treatments necessary to treat and prolong life in CF, including their unique dietary requirements, must always be followed as a first priority, with diabetes care adjusted accordingly. Early intervention with insulin has been shown to reverse clinical deterioration, even in those with mild diabetes. Newly emerging treatments for CF which have the potential to restore defective chloride channels may have implications for the development and treatment of CFRD. Whilst CFRD shares features of both type 1 and type 2 diabetes, there are important differences which necessitate a unique approach to diagnosis and management. Factors specific to CF that variably affect glucose metabolism include chronic respiratory infection and inflammation, increased energy expenditure, malnutrition, glucagon deficiency, and gastrointestinal abnormalities.
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Trottein, François, and John F. Alcorn, eds. Secondary Respiratory Infections in the Context of Acute and Chronic Pulmonary Diseases. Frontiers Media SA, 2020. http://dx.doi.org/10.3389/978-2-88963-365-4.
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Proceedings of seminar cum workshop on "chronic sunusitis & other respiratory tract infections" . New Delhi: Central Council for Research in Homoeopathy, 2007.
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Snell, Jamey, and Thomas J. Mancuso. Cystic Fibrosis. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0023.
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Cystic fibrosis (CF) is an inherited, autosomal recessive, multisystem disease. Dysfunction of the cystic fibrosis transmembrane conductance regulator protein (CFTR) in epithelial cells is the primary defect in CF. Defects in CFTR are the cause for lung disease, exocrine pancreatic insufficiency and failure, male infertility, and liver disease. CF can present with a variety of respiratory and gastrointestinal signs, including meconium ileus in the newborn period, hypernatremic dehydration, pulmonary insufficiency, nasal polyps, and insulin-dependent diabetes mellitus. As affected children grow, dysfunction in CFTR leads to chronic and progressive lung disease, characterized by suppurative infection and the development of bronchiectasis. CFTR dysfunction also affects exocrine function, leading to pancreatic insufficiency, malabsorption, and growth failure. In the past, history and physical exam with sweat chloride testing were the cornerstones of diagnosis. Diagnosis is now made with the newborn screening test for immunoreactive trypsinogen.
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Bafadhel, Mona. Prevention of respiratory disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0344.
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The prevention of disease at a population health level rather than an individual health level is aimed at reducing causes of ‘preventable’ death and, under the auspices of public health and epidemiology, is an integral part of primary, secondary, and tertiary care. Classification of death is usually according to the type of primary disease or injury. However, there are a number of recognized risk factors for death, and modifications in behaviour or risk factors can substantially reduce preventable causes of death and the associated healthcare and economic burden of chronic disease management. According to the WHO, hundreds of millions of people from infancy to old age suffer from preventable chronic respiratory diseases, there are over four million deaths annually from preventable respiratory diseases, and common respiratory disorders (e.g. lower respiratory tract infections, chronic obstructive pulmonary disease, lung cancer, and tuberculosis) account for approximately 20% of all deaths worldwide. This chapter discusses the prevention of respiratory disease, covering diseases associated with smoking (one of the biggest risk factors associated with preventable deaths), air pollution, and other lifestyle factors associated with respiratory disease; changes in legislation concerning smoking and work-related respiratory disease; and, finally, the prevention of respiratory diseases through the use of immunization and screening tools.
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Labiris, Nancy Renee. Inhaled aminoglycosides for the treatment of chronic respiratory Pseudomonas aeruginosa infections in cystic fibrosis. 2002.
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Jayne, David. Treatment of ANCA-associated vasculitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0132.
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The goals of treatment in anti-neutrophil cytoplasm antibody (ANCA) vasculitis are to stop vasculitic activity, to prevent vasculitis returning, and to address longer-term comorbidities caused by tissue damage, drug toxicity, and increased cardiovascular and malignancy risk. Cyclophosphamide and high-dose glucocorticoids remain the standard induction therapy with alternative immunosuppressives, such as methotrexate or azathioprine, to prevent relapse. Refractory disease resulting from a failure of induction or remission maintenance therapy requires alternative agents and rituximab has been particularly effective. Replacement of cyclophosphamide by rituximab for remission induction is supported by recent evidence. Additional therapy with intravenous methylprednisolone and plasma exchange is employed in severe presentations with failing vital organ function. Drug toxicity contributes to comorbidity and mortality and has led to newer regimens with reduced cyclophosphamide exposure. Glucocorticoid toxicity remains a major problem, with controversy over the rapidity with which glucocorticoids can be reduced or withdrawn. Disease relapse occurs in 50% and requires early detection at a stage when it will not adversely affect outcomes. Rates of cardiovascular disease and malignancy are higher than in control populations but strategies to reduce their risk, apart from cyclophosphamide-sparing regimens, have not been developed. Thromboembolic events occur in 10% and may be linked to the recently identified autoantibodies to plasminogen and tissue plasminogen activator. Outcomes of vasculitis depend heavily on the level of tissue damage at diagnosis, especially renal dysfunction, but are also influenced by patient age, ANCA subtype, disease extent, and response to therapy. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)is treated along similar principles to granulomatosis with polyangiitis (GPA) and microscopic polyangiitis but the persistence of steroid-dependent asthma in over one-third and differences in pathogenesis has suggested alternative treatment approaches. Chronic morbidity results from tissue damage and is especially common in the upper and lower respiratory tract and kidneys. Tracheobronchial disease is a severe late complication of GPA, while deafness, nasal obstruction, and chronic sinusitis are sequelae of nasal and ear vasculitis. Chronic infection of damaged epithelial surfaces acts as a drive for vasculitic activity and adequate infection control is necessary for stable remission. Chronic kidney disease can stabilize for many years but the risks of endstage renal disease (ESRD) are increased by acute kidney injury at presentation or renal relapse. Renal transplantation is successful, with similar outcomes to other causes of ESRD.
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Bowker, Lesley K., James D. Price, Ku Shah, and Sarah C. Smith. Chest medicine. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198738381.003.0011.
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This chapter provides information on the ageing lung, respiratory infections, influenza, pneumonia, pneumonia treatment, vaccinating against pneumonia and influenza, pulmonary fibrosis, rib fractures, pleural effusions, pulmonary embolism, aspiration pneumonia/pneumonitis, lung cancers, chronic cough, presentation of tuberculosis, tuberculosis investigation, treatment of tuberculosis, assessment of asthma and chronic obstructive pulmonary disease (COPD), drug treatment of asthma and COPD, non-drug treatment of asthma and COPD, oxygen therapy, and asbestos-related disease.
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J, Judd Sandra, ed. Respiratory disorders sourcebook: Basic consumer health information about infectious, inflammatory, and chronic conditions affecting the lungs and respiratory system, including pneumonia, bronchitis, influenza, tuberculosis, sarcoidosis, asthma, cystic fibrosis, chronic obstructive pulmonary disease, lung abscesses, pulmonary embolism, occupational lung diseases, and other bacterial, viral, and fungal infections; along with facts about the structure and function of the lungs and airways, methods of diagnosing respiratory disorders, and treatment and rehabilitation options, a glossary of related terms, and a directory of resources for additional help and information. 2nd ed. Detroit: Omnigraphics, 2008.
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Macagno, Francesco, and Massimo Antonelli. Therapeutic strategy in acute or chronic airflow limitation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0112.
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The fragility of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accounts for their frequent hospitalization and their high intensive care unit risk. Therapy for AECOPD is varied and the need for hospitalization must be always carefully evaluated, considering the risk factors related to the presence of multi-resistant pathogens or the need of invasive procedures. The prolonged use of oxygen therapy requires an accurate monitoring of blood gases and continuous oximetry. Inhalation therapy can be performed using nebulizers, predosed aerosols or powders for inhalation. Corticosteroids for oral and systemic use now play an established role in AECOPD, because bacterial infections account for 50% of exacerbations. Non-invasive ventilation (NIV) must be considered the first option in AECOPD patients and acute respiratory failure if there are no contraindications. The careful monitoring of the patient and the response to NIV are indispensable elements for therapeutic success.
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Frew, Anthony. Air pollution. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0341.
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Any public debate about air pollution starts with the premise that air pollution cannot be good for you, so we should have less of it. However, it is much more difficult to determine how much is dangerous, and even more difficult to decide how much we are willing to pay for improvements in measured air pollution. Recent UK estimates suggest that fine particulate pollution causes about 6500 deaths per year, although it is not clear how many years of life are lost as a result. Some deaths may just be brought forward by a few days or weeks, while others may be truly premature. Globally, household pollution from cooking fuels may cause up to two million premature deaths per year in the developing world. The hazards of black smoke air pollution have been known since antiquity. The first descriptions of deaths caused by air pollution are those recorded after the eruption of Vesuvius in ad 79. In modern times, the infamous smogs of the early twentieth century in Belgium and London were clearly shown to trigger deaths in people with chronic bronchitis and heart disease. In mechanistic terms, black smoke and sulphur dioxide generated from industrial processes and domestic coal burning cause airway inflammation, exacerbation of chronic bronchitis, and consequent heart failure. Epidemiological analysis has confirmed that the deaths included both those who were likely to have died soon anyway and those who might well have survived for months or years if the pollution event had not occurred. Clean air legislation has dramatically reduced the levels of these traditional pollutants in the West, although these pollutants are still important in China, and smoke from solid cooking fuel continues to take a heavy toll amongst women in less developed parts of the world. New forms of air pollution have emerged, principally due to the increase in motor vehicle traffic since the 1950s. The combination of fine particulates and ground-level ozone causes ‘summer smogs’ which intensify over cities during summer periods of high barometric pressure. In Los Angeles and Mexico City, ozone concentrations commonly reach levels which are associated with adverse respiratory effects in normal and asthmatic subjects. Ozone directly affects the airways, causing reduced inspiratory capacity. This effect is more marked in patients with asthma and is clinically important, since epidemiological studies have found linear associations between ozone concentrations and admission rates for asthma and related respiratory diseases. Ozone induces an acute neutrophilic inflammatory response in both human and animal airways, together with release of chemokines (e.g. interleukin 8 and growth-related oncogene-alpha). Nitrogen oxides have less direct effect on human airways, but they increase the response to allergen challenge in patients with atopic asthma. Nitrogen oxide exposure also increases the risk of becoming ill after exposure to influenza. Alveolar macrophages are less able to inactivate influenza viruses and this leads to an increased probability of infection after experimental exposure to influenza. In the last two decades, major concerns have been raised about the effects of fine particulates. An association between fine particulate levels and cardiovascular and respiratory mortality and morbidity was first reported in 1993 and has since been confirmed in several other countries. Globally, about 90% of airborne particles are formed naturally, from sea spray, dust storms, volcanoes, and burning grass and forests. Human activity accounts for about 10% of aerosols (in terms of mass). This comes from transport, power stations, and various industrial processes. Diesel exhaust is the principal source of fine particulate pollution in Europe, while sea spray is the principal source in California, and agricultural activity is a major contributor in inland areas of the US. Dust storms are important sources in the Sahara, the Middle East, and parts of China. The mechanism of adverse health effects remains unclear but, unlike the case for ozone and nitrogen oxides, there is no safe threshold for the health effects of particulates. Since the 1990s, tax measures aimed at reducing greenhouse gas emissions have led to a rapid rise in the proportion of new cars with diesel engines. In the UK, this rose from 4% in 1990 to one-third of new cars in 2004 while, in France, over half of new vehicles have diesel engines. Diesel exhaust particles may increase the risk of sensitization to airborne allergens and cause airways inflammation both in vitro and in vivo. Extensive epidemiological work has confirmed that there is an association between increased exposure to environmental fine particulates and death from cardiovascular causes. Various mechanisms have been proposed: cardiac rhythm disturbance seems the most likely at present. It has also been proposed that high numbers of ultrafine particles may cause alveolar inflammation which then exacerbates preexisting cardiac and pulmonary disease. In support of this hypothesis, the metal content of ultrafine particles induces oxidative stress when alveolar macrophages are exposed to particles in vitro. While this is a plausible mechanism, in epidemiological studies it is difficult to separate the effects of ultrafine particles from those of other traffic-related pollutants.
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Simon, Chantal, Hazel Everitt, Francoise van Dorp, Nazia Hussain, Emma Nash, and Danielle Peet. Oxford Handbook of General Practice. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198808183.001.0001.
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The Oxford Handbook of General Practice offers hands-on advice to help with any day-to-day problems that might arise in general practice, and covers the entire breadth and depth of general practice in concise, quick-reference topics. It starts by exploring the definition of general practice, and moves on to practical advice on practice management, consulting with patients, social aspects of primary care, and prescribing and managing medicines. It gives practical advice on all clinical areas of general practice, including minor surgery, healthy living, chronic disease and elderly care, cardiology and vascular disease, respiratory medicine, endocrinology, gastrointestinal medicine, renal medicine and urology, musculoskeletal problems, neurology, dermatology, infectious disease, haematology and immunology, breast disease, gynaecology, sexual health and contraception, pregnancy, child health, ear, nose, and throat medicine, ophthalmology, mental health, cancer care, palliative care, and emergencies in general practice. It is written for general practitioners (GP), GPs in training, medical students, and allied health professionals working in the community.