Revue médicale suisse
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Asthma and COPD are often considered mutually exclusive diseases, mainly because of the inclusion of only typical cases of asthma or COPD in therapeutic clinical trials. However, clinicians are unable to distinguish between both conditions in a substantial number of patients, a situation that may be called the "asthma-COPD overlap syndrome". It is important to recognize this entity, as patients suffering from an asthma-COPD overlap syndrome are more symptomatic, have a poorer quality of life and suffer more exacerbations than patients with asthma or COPD alone. In the absence of studies specifically designed to assess the treatment modalities for these patients, it appears wise to prescribe inhaled corticosteroids early in the course of the disease, considering their established efficacy in asthma.
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Revue médicale suisse · Oct 2015
[Doctor, I am having trouble breathing, an in-hospital point of view].
Breathlessness is frequent in the hospital setting: almost 50% of seriously ill hospitalised patients complain of dyspnoea, and its presence aggravates morbidity and mortality. Evaluation of breathlessness, based on self-report, must be completed with the measurement of vital signs and with a search for clinical signs of serious problems - desaturation, stridor, use of accessory muscles or alteration of mental status - that need urgent treatment. After this first therapeutic step, the diagnostic strategy consists of a multidisciplihary approach to determine the physiopathological mechanisms of dyspnoea that will determinate its final management.
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The refeeding syndrome is frequent and potentially deadly, still it is underdiagnosed. It is defined by clinical and biological manifestations that are seen upon refeeding of malnourished patients. ⋯ Riskconditions are well summarized by the NICE criteria. To avoid refeeding syndrome, it is fundamental to find and correct any electrolytic deficiency and to give thiamine before starting a slow and progressive oral, enteral or parenteral refeeding.