Useful Information for Health Professionals
Although respiratory function tests are an integral part of diagnosis and management of respiratory diseases, they are not diagnostic for any given disease. Respiratory function tests may be able to identify and quantify respiratory system functional abnormalities years before other investigations become abnormal or patients become worry about their symptoms (figure 1).
Cardiopulmonary Exercise Testing (CPET)
CPET involves measurements of the cardiac, metabolic and respiratory systems whilst the patient exercises to maximum capacity.
Obstructive sleep apnoea (OSA) is a disorder in which breathing is repetitively interrupted during sleep due to collapse of the upper airway. An apnoea is defined as complete cessation of breathing lasting 10 seconds or greater. OSA causes hypertension and neurocognitive impairment whilst severe OSA predisposes to coronary artery disease, stroke and increased mortality.
Intermittent hypoxemia causes abnormal metabolic response
OSA primarily affects the respiratory system during sleep by compromising upper airway and limiting air and oxygen flow into the lungs. Apnoea is defined as cessation of airflow for ≥ 10 seconds and hypopnoea is defined by a drop of ≥30% in air flow for ≥10 seconds associated with ≥3% oxygen desaturation. Averaging the number of apnoeas and hypopnoeas in one hour of sleep study is called AHI (apnoea hypopnoea index) which is used to determine the severity of the disease as below:
Insomnia is the most common sleep disorder affecting up to 40-50% of the population at any given time. It is a distressing difficulty with sleep onset, sleep maintenance, or waking too early where these ‘sleep times’ take longer than 30 minutes. These symptoms need to occur at least three times or more per week and have been present for more than 3 months to be defined as chronic.
Circadian rhythms are the physiological and behavioural changes occurring in the body approximately every 24 hours. These rhythms need to be entrained to the environment on a daily basis. There are five types of circadian rhythm sleep disorders (see below). Delayed and Advanced Sleep Phase Disorders will be discussed in greater detail.
Shift work sleep disorder consists of symptoms of insomnia or excessive sleepiness that occur as transient phenomena in relation to work schedules (ICSD).
Combo Therapy May Increase Long-term Survival in PAH
(AMBITION trial Post-hoc analysis)
• The pleural space contains 10-25 millilitres of fluid
• Created in the pleural capillaries and lymphatics, largely reabsorbed via the lymphatics of the parietal pleura
• > 3000 /million population develop pleural effusion each year
• There are 60 different causes of pleural effusions
• Left ventricular failure is the most common cause
A decission aid for people considering lung cancer screening with low-dose computed tomography
If you have smoked for many years, you may want to think about screening (testing) for lung cancer with low-dose computed tomography (LDCT). Before deciding, you should think about the possible benefits and harms of lung cancer screening. This decision aid will help prepare you to talk with your health care professional about whether lung cancer screening is right for you.
Why and How?
Pulmonary Vascular Disease
PAH group 1
• Chronic precapillary PH, PCWP<15
• 6 per million per year incidence
• 15-50 / million
• 14 drugs are approved
• Lung and heart Tx still very relevant
Our position in 2019
• NEJM series
• ERS 2019