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By Duncan M. Geddes MD, MRCP (auth.)

ISBN-10: 9400980787

ISBN-13: 9789400980785

ISBN-10: 9400980809

ISBN-13: 9789400980808

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Bronchial wall thicken'illg produces tramline shadows especially in the lower zones. Peripheral ring shadows are formed by cystic bronchi. Patchy periplieral shadowing is caused by pneumonia, collapse or fibrosis. Bronchograms make the definitive diagnosis, but they are not usually necessary unless surgery is contemplated, when they are b c 44 Airways Obstruction used to define the extent of the disease. Bronchiectasis affecting the proximal bronchi with a normal peripheral pattern suggests bronchopulmonary aspergillosis.

Spirometry is sufficient for this. The assessment is best done when the patient first complains of breathlessness. Chronic Bronchitis 29 Patients with moderate or severe breathlessness should have a trial of prednisone, 30 mg daily for two weeks, and spirometry should then be repeated. If there is a greater than five per cent increase in FEV 1 or FVC and symptomatic improvement, longterm steroid therapy should be considered. , will usually maintain the spirometric improvement, and only if this fails should oral prednisone be continued.

All children of a ZZ will carry the Z allelle and if such an individual marries an MZ heterozygote, half their offspring will be at serious risk. Genetic counselling is important since ZZ homozygotes are usually of reproductive age. The management of the emphysema itself is conducted along conventional lines. Heterozygotes The phenotypes MS, MZ have intermediate levels of at antitrypsin. Detailed studies of such individuals have shown a slight impairment of lung function, especially among smokers.

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Airways Obstruction by Duncan M. Geddes MD, MRCP (auth.)

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