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Background: Smoking cessation advice is important for reducing the worldwide burden of disease resulting from tobacco smoking. Appropriate risk communication formats improve the success of counselling interventions in primary care. Aims: To test the feasibility and acceptance of a smoking cessation counselling tool with different cardiovascular risk communication formats including graphs, in comparison with the International Primary Care Respiratory Group (IPCRG) ‘quit smoking assistance’ tool. Methods: GPs were randomised into an intervention group (using our communication tool in addition to the IPCRG sheet) and a control group (using the IPCRG sheet only). We asked participants for socioeconomic data, smoking patterns, understanding of information, motivation, acceptance and feasibility, and measured the duration and frequency of counselling sessions. Results: Twenty-five GPs performed 2.8 counselling sessions per month in the intervention group and 1.7 in the control group (p=0.3) with 114 patients. The median duration of a session was 10 mins (control group 11 mins, p=0.09 for difference). Median patients' motivation for smoking cessation was 7 on a 10-point visual analogue scale with no significant difference before and after the intervention (p=0.2) or between groups (p=0.73 before and p=0.15 after the intervention). Median patients' ratings of motivation, self-confidence, understanding of information, and satisfaction with the counselling were 3–5 on a 5-point Likert scale, similar to GPs' ratings of acceptance and feasibility, with no significant difference between groups. Conclusions: Among Swiss GPs and patients, both our innovative communication tool and the IPCRG tool were well accepted and both merit further dissemination and application in research.

Background/Aim: Pivotal objectives of self-management programs are behavior change, coping and better health related quality of life (HRQL). The effects of the “Living well with COPD” (LWWCOPD) self-management program and usual care on coping, HRQL, smoking cessation and exacerbation frequency at 24 months were compared in COPD patients from primary care. Method: Prospective non-randomized controlled study with COPD patients who participated in the “LWWCOPD” program adapted to primary care in Switzerland. COPD patients from the primary care-based COPD Cohort ICE COLD ERIC(http://www.ClinicalTrials.govNCT00706602) served as control. The primary outcome was coping measured by the mastery domain of the Chronic Respiratory Questionnaire (CRQ). We performed multivariate regression analyses where we accounted for the lack of randomization with propensity scores. Results: 71 patients were in the self- management and 385 in the usual care cohort. Patients with the self-management program had significantly higher mastery scores (0.71(95% CI 0.28-1.13)), significantly less moderate to severe exacerbations (incidence rate ratio 0.68(95% CI 0.48-0.97)) and significantly more patients quit smoking (odds ratio 0.26 (95% CI 0.07-0.95). There was an effect on fatigue (0.75(95% CI 0.28-1.22)) whereas the effect just did not reach statistical significance for dyspnea (0.50, 95% CI -0.03-1.03) and emotional function (0.40, 95% CI -0.03-0.82, all CRQ). Conclusion: The LWWCOPD intervention in a primary care setting showed long-term benefits on coping, exacerbations and smoking cessation behavior.

A case of a malignant peritoneal mesothelioma in a 63-year-old male patient with a history of exposure to Thorotrast in 1945 is presented. There was no history of exposure to asbestos. The clinical manifestation was a serosal effusion, which required weekly ascites puncture until therapy with intraperitoneal bleomycin was initiated. The latter treatment led to a significant reduction of ascites without any influence on tumor progression. Unfortunately, intraperitoneal bleomycin was accompanied by pulmonary toxicity, but at a higher total dose than known for intravenous administration. Three years after diagnosis the patient is still alive, without relapse of ascites production after bleomycin had to be stopped. Considering the risk of pulmonary fibrosis with high-dose intraperitoneal bleomycin and the lack of efficacy on tumor reduction, bleomycin seems to offer no advantage with respect to cisplatin.

Asthma is a common, chronic inflammatory airway disease associated with prominent health and economic consequences. In the first National Heart Lung and Blood Institute (NHLBI) and Global Initiative for Asthma (GINA) guidelines the level of symptoms and airflow limitation and its variability subdivided asthma by severity into four subcategories (intermittent, mild persistent, moderate persistent, and severe persistent). In the new GINA guidelines asthma control is emphasized as a main goal and a periodic assessment of asthma control is recommended. The three subcategories are controlled, partly controlled and uncontrolled asthma. The achievement and maintenance of asthma control is a long-term process with focus on: (1.) diagnosis and objective evaluation of disease activity, (2.) Adequate pharmacotherapy and reevaluation of response to therapy, (3.) regular follow up, and (4.) self-management education. This article presents an overview on pharmacotherapy for adult asthmatics, with emphasise on the importance of achieving and to maintain control.

Voluntary hyperventilation (HV) provokes hemoconcentration due to a loss of fluid from the intravascular space. In 10 healthy male volunteers the hypothesis was tested whether HV increases transcapillary fluid shift into the interstitial compartment. For this purpose, fluorescent light intensity (FLI) alterations after intravenous injection of sodium fluorescein (Na fluorescein) before and during 3 min of HV were determined. Concomitantly, temperature and microvascular skin flux (laser Doppler fluxmetry, LDF) were recorded continuously. Hematocrit and serum proteins, as markers of hemoconcentration, increased significantly from 41.2 +/- 2.3 to 42.7 +/- 2.0% (p = 0.0023) and from 69.5 +/- 3.4 to 72.9 +/- 3.0 g/l (p = 0.0005, respectively). Skin temperature and LDF showed no changes during HV compared to baseline levels. Interstitial FLI indicating transcapillary diffusion of Na fluorescein was significantly higher (p0.001) during HV compared to the values recorded during the baseline period. The exact mechanism of enhanced transcapillary diffusion of Na fluorescein is not known. The distinct increase in FLI without a significant change in microvascular skin flux suggests an HV-induced increase in capillary pressure or an enhancement in capillary permeability for water and small solutes.

The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified. A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data. Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976-1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) 1.37-1.77), number-needed-to-treat 5.8 (95% CI 4.5-8.1). There was no evidence of any effect of study period (12-24 weeks) or cumulative dose of NAC on efficacy. In five trials, 286 of 466 (61.4%) patients receiving NAC reported improvement of their symptoms compared with 160 of 462 (34.6%) patients receiving placebo (relative benefit 1.78 (95% CI 1.54-2.05), number-needed-to-treat 3.7 (95% CI 3.0-4.9)). With NAC, 68 of 666 (10.2%) patients reported gastrointestinal adverse effects compared with 73 of 671 (10.9%) taking placebo. With NAC, 79 of 1,207 (6.5%) patients withdrew from the study due to adverse effects, compared with 87 of 1,234 (7.1%) receiving placebo. In conclusion, with treatment periods of approximately 12-24 weeks, oral N-acetylcysteine reduces the risk of exacerbations and improves symptoms in patients with chronic bronchitis compared with placebo, without increasing the risk of adverse effects. Whether this benefit is sufficient to justify the routine and long-term use of N-acetylcysteine in all patients with chronic bronchitis should be addressed in further studies and cost-effectiveness analyses.

INTRODUCTION: Decision support software offers an opportunity to improve the care of patients with asthma by linking individual management decisions to guidelines. METHOD: A guidelines based software package linked to a large database and incorporating a morbidity predictive function was developed in the United Kingdom. Clinicians from several European countries volunteered to evaluate the package in their own clinical environment. RESULTS: The package was run during consultations with patients in the UK, Portugal, Switzerland and Italy. Clinicians agreed on a need for local translations, local drug choices and guidelines to be developed. An emphasis on allergy, immunology and smoking cessation advice in asthma care in some countries highlighted a need to adapt country specific versions. CONCLUSIONS: This International pilot study demonstrated that clinicians can learn from each other and work together around a common theme of implementing guidelines using decision support software.

Background Takayasu's arteritis is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. Female gender in reproductive age and Asian origin are known factors associated with higher disease prevalence. The clinical manifestations vary considerably and are typically caused by limb or organ ischemia illness and fever. The estimated incidence rate in the western world is 2.6 cases per million persons per year. Occasionally, exertional dyspnea can be the sole primary clinical manifestation of Takayasu's arteritis. Case presentation We report the case of a 57-year-old woman who was referred to our institution with increasing exertional dyspnea caused by pulmonary artery involvement in Takayasu's arteritis. In a review of the literature we discuss demographic data, clinical and radiographic findings and available therapeutic options. Conclusions Dyspnea due to pulmonary artery involvement can be the initial symptom of Takayasu's arteritis. Simple clinical tests, including a complete pulse-status and blood pressure measuring at both arms can lead to the right diagnosis and should always be done beyond the auscultation of the heart and lungs in patients with dyspnea.