Respiratory

Respiratory

Philippe GrunsteinEmphysema
Philippe Grunstein (Consultant Respiratory Medicine)

Dr Philippe Grunstein trained in General Medicine in Amiens. He is a Consultant in Respiratory Medicine and Associate Professor at St George’s University School of Medicine. He specialises in Intensive Care and Sleep Medicine

COPD is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs. Classically we used to differentiate between pink puffers and blue bloaters, depending upon whether they had predominantly emphysema or chronic bronchitis ( emphysema classically leading to a hypercatabolic state with hyperventilation versus the bloated cyanotic state of the bronchitic with V/Q mismatch and cor pulmonalae). In reality patients have mixed states and the important feature to note is to recognise when they are becoming hypercapnic.

This lecture by Philippe concentrates on the management of patients with emphysema, how to recognise and manage them when they deteriorate.

This is a very engaging lecture in which Philippe passes on several very useful insights into patient assessment and management.

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Philippe GrunsteinSleep Apnoea
Philippe Grunstein (Consultant Respiratory Medicine)

Dr Philippe Grunstein trained in General Medicine in Amiens. He is a Consultant in Respiratory Medicine and Associate Professor at St George's University School of Medicine. He specialises in Intensive Care and Sleep Medicine

Philippe's talk is fascinating, and is recommended to all primary care doctors, because the subject is so important for us to recognise and manage. Notwithstanding that, we are sure that you will find Philippe's delivery unique and refreshing: "I will ask you to forget the epworth sleepiness scale, which is extremely bad... for instance it asks you whether you fall asleep at the theatre,... some people never go to the theatre...the correlation between the epworth and the index of apneoa is absolutely miserable... it is like tossing a coin"

Dig into this lecture several times, it delivers all you need to create a very effective management program for your patients. It is also a masterclass in how to take a history from a patient, as it tells you of the critical questions you need to ask patients in order to properly assess them.

Obstructive sleep apnea (OSA) is a relatively common disorder that affects people of all ages, but is most prevalent among the middle-aged and elderly. Affected individuals experience repeated collapse and obstruction of the upper airway during sleep, which results in reduced airflow (hypopnea) or complete airflow cessation (apnea), oxygen desaturation, and arousals from sleep. Adverse clinical outcomes associated with OSA include: cardiovascular disease, hypertension, non-insulin-dependent diabetes, and increased likelihood of motor vehicle and other accidents due to daytime hypersomnolence.

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Ajay KamathAsthma
Ajay Kamath (Consultant Respiratory Physician)

The majority of patients with asthma are treated in the primary care setting. It is the GP therefore who is in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. With the prevalence of asthma rising it is becoming one of the mainstays of chronic disease management in primary care. Ajay Kamath is a Consultant Respiratory Physician , and his lecture here is a comprehensive and reflective account of asthma management.

In Part 1 Ajay discusses diagnosis.
In Part 2 of his lecture Ajay deals with standard management of asthma care and in Part 3 he deals with the problems of difficult to manage asthma, asthma in pregnancy and occupational asthma.

All in all, this is an essential lecture, and one well worth repeating carefully to obtain the most benefit out of it.

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