Smoking continues to be the main preventable cause of death in the UK. Tobacco consumption causes a wide range of diseases and other adverse effects, including multiple types of cancer, chronic obstructive pulmonary disease, cardiovascular disease, pregnancy complications, cataracts and osteoporosis. The Government's vision to 'make every contact count' emphasises community nurses' responsibility and key potential to promote healthier living and behaviour.

This article reviews the latest evidence on supporting smokers in practice and argues that nurses working in the community are ideally placed to record smoking status, give advice, encouragement and support, refer people to local smoking cessation services and offer pharmacological treatment.

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A wireless portable monitoring system for respiratory diseases using micro sensors is proposed. The monitoring system consists of two sensor nodes integrating with Bluetooth transmitters that measure users respiratory airflow, blood oxygen saturation, and body posture. The utility of micro hot-film flow sensor makes the monitor can acquire comprehensive respiration parameters which are useful for diagnoses of OSA, COPD and asthma. The system can serve as both sleep recorder and spirometer. Additionally, a mobile phone or a PC connecting with Internet serving as a monitoring and transfer terminal makes telemedicine achievable.

Several experiments were conducted to verify the feasibility and effectiveness of the proposed system for monitoring and diagnosing OSA, COPD and asthma.

Difficult asthma: Assessment and management, Part 1.

Allergy Asthma Proc. 2012 Jul;33(4):305-12

Authors: Long AA, Fanta CH

Abstract
A minority of asthma patients have disease that proves difficult to control with usual medications and experience ongoing symptoms, poor quality of life, and limitations in activity and/or frequent asthma exacerbations. This group of patients accounts for much of the expense associated with asthma care and is the focus of national and international collaborative study groups. Distinguishing between "difficult-to-manage asthma" and truly "therapy-resistant asthma" is helpful and promotes a systematic consideration of contributory factors. Critical evaluation of factors contributing to difficult-to-manage asthma including adverse environment, comorbidities, nonadherence, and incorrect diagnosis is recommended in a systematic fashion in Part 1 of this contribution.

PMID: 22856631 [PubMed - in process]

Difficult asthma: Assessment and management, Part 2.

Allergy Asthma Proc. 2012 Jul;33(4):313-23

Authors: Fanta CH, Long AA

Abstract
Patients with severe asthma have considerable morbidity related to their asthma and are at risk for serious, life-threatening exacerbations. Their management requires an intensive and comprehensive approach, including attention to reducing exposure to environmental inciters of airway inflammation and triggers of symptoms, patient education (including an asthma action plan), and opportunity for close patient-provider communication. Approved medical options include the lipoxygenase inhibitor, zileuton; the anti-immunoglobulin E monoclonal antibody, omalizumab; and bronchial thermoplasty. Nonapproved interventions of potential benefit are ultrahigh-dose inhaled corticosteroids, anticholinergic bronchodilators (tiotropium), macrolide antibiotics, and vitamin D supplementation for the vitamin D-deficient patient. Potentially toxic, "steroid-sparing" therapies such as methotrexate, cyclosporine, and etanercept are best reserved for patients participating in clinical trials. Recognition of specific subtypes of patients with therapy-resistant asthma permits more targeted treatment approaches, such as for aspirin-sensitive asthma, persistent eosinophilic asthma, asthma complicated by allergic bronchopulmonary aspergillosis, asthma with persistent airflow obstruction, and asthma with life-threatening (near fatal) asthmatic attacks. Novel therapies based on an improved understanding of the pathobiology of therapy-resistant asthma are greatly needed.

PMID: 22856632 [PubMed - in process]