Background: A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. Methods: A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. Results: Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p,0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p,0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p,0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p,0.001. Conclusions: The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality.
Background Between 2006 and 2011, 161 patients were referred for formal ambulatory oxygen assessment at the Newcastle RVI. Their results have been reviewed. Method The assessments comprised three 6-min walk tests (6MWT) supervised by a trained healthcare professional as per BTS guidelines (2006). Test 1: On room air (RA) Test 2: On room air with the oxygen supply switched off Test 3: On oxygen 4 l/min via nasal cannulae Minimum SpO 2 during exercise, distance walked and oxygen flow rate required to maintain SpO 2 above 90% were recorded together with the respiratory diagnosis and basic demographic details. Results 18 patients were excluded as they did not de saturate on walk 1 or were unable to complete the 6MWT. 143 patients' results were analysed. 82 were male with 61 female. The two commonest clinical diagnoses were Interstitial Pulmonary Fibrosis (IPF) and COPD. IPF patients walked on average 70 m (31%) further than COPD patients on room air. They had the greatest increase in oxygen saturation when exercising on supplemental oxygen (12%) but had the lowest improvement in walking distance (7.3%). There was no relationship between improvement in walk test distance and improvement in oxygenation in any of the subgroups. Conclusion Further studies may be needed to explore the relative benefits of ambulatory oxygen in non-COPD patients.
A 78-year-old woman on ciclosporin for aplastic anaemia presented to her general practitioner with a 2 cm cystic swelling on the right side of her forehead. After a period of 8 months the lesion ruptured and, despite good wound care, failed to heal over a period of seven further months. Imaging demonstrated an invasive process and a biopsy was taken, which showed granulomatous inflammation that stained positively for mycobacteria. Further investigation with cross-sectional imaging revealed no other sites of disease. The only history of exposure to tuberculosis was 64 years prior to presentation. Differential diagnoses of mycetoma, autoimmune disease and non-tuberculous mycobacterial infection were considered, but culture confirmed tuberculosis. This case demonstrates an unusual presentation of isolated cutaneous tuberculosis in a patient with suppressed immune function.
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