Pulmonary medicine

Summary points

• Long acting bronchodilators should not be prescribed without inhaled corticosteroids in asthma

• When asthma symptoms persist despite regular use of inhaled corticosteroids, βagonists or theophylline may be preferred to increasing the dose of corticosteroids

• Oral leukotriene modulators may be useful for patients who do not respond adequatelyto usual doses of corticosteroids

• Pulmonary rehabilitation (including exercise reconditioning) is effective in breathless patients at virtually all stages of chronic obstructive pulmonary disease

• Lung volume reduction surgery is also effective in patients with emphysema who have severe disability due to severe airway obstruction and lung hyperinflation

• Prediction rules have been developed to identify patients who should be referred to hospital with community acquired pneumonia

• Directly observed and fixed dose combination therapy are more cost effective than conventional treatment of active tuberculosis