Intended for healthcare professionals

Clinical Review Recent advances

Pulmonary medicine

BMJ 1999; 318 doi: (Published 16 January 1999) Cite this as: BMJ 1999;318:171
  1. Nicolas Roche (, assistant in pulmonary medicine.
  1. Service de Pneumologie, Hôpital Ambroise Paré, F-92104 Boulogne, France
  1. Correspondence to: Dr Roche, Imperial College School of Medicine, National Heart and Lung Institute, London SW3 6LY

    Respiratory medicine covers a great variety of disorders that are common in general clinical practice, and many important papers have been published on these illnesses in the past few years. Since the volume of published articles makes it almost impossible for doctors to be informed of all recent developments in medicine, this review aims to provide practical information on recent scientific evidence that may change practice in 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


    The large number of publications each year makes a classic Medline search unsuitable for a literature review on “recent advances” in a given specialty. However, database searches do show the number of papers published on selected topics, which may reflect the amount of research and new information (table 1).

    View this table:
    Table 1

    Results of Medline search for articles published between February 1997 and February 1998 in some areas of pulmonary medicine

    The references in this review have been identified by regular reading of the following journals: American Journal of Respiratory and Critical Care Medicine, Chest, Thorax, Respiratory Medicine, Respiration, Respirology …

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