Category Archives: Respiratory

Noisy breathing in newborns

Posted on August 2, 2018 by Dr Sarah

Periodic increases/decreases in breathing sounds are normal in babies. Wheeze: Can be infection (mild or serious) or heart failure. Check for signs of heart problems; murmur, absent femorals, etc. Check sats. Normal sats and normal feeding are reassuring. If any … Continue reading →

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COPD algorithm

Posted on September 8, 2017 by Dr Sarah

This is our practice algorithm for COPD treatment: Treat intermittent symptoms with a SABA. If more severe, differentiate between low-risk and high-risk patients. Low-risk patients are those with: FEV1 >50% <2 exacerbations/yr For low-risk patients: First-line treatment: LAMA If symptoms … Continue reading →

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Community acquired pneumonia in children

Posted on March 10, 2017 by Dr Sarah

Signs of severity Temperature 38.5 or greater RR >70 in infants or >50 in older children Moderate to severe recession in infants Severe dyspnoea in children Nasal flaring Grunting Intermittent apnoea in infants Sats <95% (this was what the BMJ … Continue reading →

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Exercise-induced laryngeal obstruction

Posted on October 9, 2016 by Dr Sarah

The cause of EILO is unclear, but it may be due to laryngeal hypersensitivity. It’s most common in athletic females under 20. Symptoms include shortness of breath, throat discomfort, chest tightness, and wheeze developing during intense exercise. EILO, for obvious … Continue reading →

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Occupational asthma

Posted on August 1, 2016 by Dr Sarah

Occupational asthma is caused by an immune reaction to specific agents that are inhaled in the workplace. There are around 400 causative agents, although a small number of these cause most cases. It is different from work-aggravated asthma. Frequently affected … Continue reading →

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Pulmonary fibrosis

Posted on January 18, 2016 by Dr Sarah

Causes include: chemical or dust inflammation idiopathic (idiopathic pulmonary fibrosis or cryptogenic fibrosing alveolitis) local fibrosis from infection or infarction various congenital syndromes – neurofibromatosis, Gaucher’s disease, Niemann-Pick disease, tuberous sclerosis. various acquired inflammatory conditions – RA, AS, Sjogren’s, systemic … Continue reading →

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Exercise-induced bronchoconstriction in adults

Posted on January 17, 2016 by Dr Sarah

This is transient constriction of the lower airways induced by vigorous exercise, and may or may not be associated by asthma. It is no longer referred to as ‘exercise-induced asthma’. It is caused by dehydration of the respiratory mucosa, due … Continue reading →

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Chronic refractory cough

Posted on January 16, 2016 by Dr Sarah

Known by other names (chronic idiopathic cough, unexplained chronic cough), it is defined as: A cough that persists despite specialist guideline treatment. This of course means it is a diagnosis of exclusion. It is either one form of cough hypersensitivity … Continue reading →

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Wheezing in pre-school children

Posted on February 14, 2014 by Dr Sarah

I never quite understood why wheezing in pre-school children is not meant to be called asthma when it looks like asthma, sounds like asthma and behaves like asthma, but apparently the reason is the absence of eosinophilic airways inflammation. Some … Continue reading →

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Prescribing tips

Posted on June 1, 2013 by Dr Sarah

I was taught that prednisolone courses for COPD exacerbations should be two weeks plus a wean-off, but have noticed that most people seem to use five days. The controversy is now resolved – the REDUCE trial, an RCT in Switzerland, … Continue reading →

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