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

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This may improve cor pulmonale and therefore mortality. Until long-term benefits have been assessed, this treatment should not be recommended as it is inconvenient and expensive. Polycythaemia When the haematocrit exceeds 60 per cent, the patient may benefit from venesection. One or two pints are removed over an hour and replaced with Dextran 40. When successful, the patient notices improved exercise tolerance and mental function. Respiratory Failure See Chapter 8. 4. Emphysema and Bullae Emphysema Definition Emphysema is an increase in size of the air spaces distal to the terminal bronchiole with destruction of their walls.

Recent work has suggested that inspiration of cold air may be the main cause of exercise-induced asthma. Irritants, chemicals and cold. Mediator release and the autonomic nervous system can both be implicated. Irritants cause cough and asthma very rapidly after inhalation and it is likely that these effects are mediated by the parasympathetic nervous system. Atropine can often block this response. g. colophony resin in solder flux, byssinosis caused by cotton bracts (Plate 10) and toluene di-isocyanates in paint manufacture.

Colophony resin in solder flux, byssinosis caused by cotton bracts (Plate 10) and toluene di-isocyanates in paint manufacture. Cold may provoke a mixed response in that atropine may block the asthma, but some patients also develop urticaria on exposure of the skin to cold and this suggests local mediator release. Psychological factors. While these are undoubtedly important in a few patients, the factors discussed above usually dominate. Host Factors Atopy. The tendency to develop type I allergic reactions is called atopy.

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