Potential benefits of integrated COPD management in primary care.

Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis.

Tuberculosis in oncology patients.

BACKGROUND: There is a dearth of studies addressing the incidence and clinical presentation of tuberculosis (TB) in children with cancer. AIM: To evaluate the incidence of TB in paediatric oncology patients at Tygerberg Hospital, located in a Cape Town area of high TB prevalence, and to describe the clinical characteristics of the disease in this particular group of patients whose treatment typically suppresses their immune response. METHODS: We reviewed the records of 625 paediatric oncology patients admitted from 1 January 1991 to 31 December 2005. Of these, 87 received treatment for TB; however, only 57 cases had sufficient data to support a diagnosis of TB and only these were used for further analysis. RESULTS: In the children with TB, acute lymphoblastic leukaemia (ALL) was the most common malignancy (13/57, 22.8%). The incidence of TB in the study group was 9117/100,000/year, which is 22 times higher than the overall TB incidence reported in children from a similar background. Importantly, 47% of the active infections appeared in the 1st 5 months of chemotherapy, suggesting reactivation of latent TB. CONCLUSIONS: Identifying latent TB in our patients and providing prophylactic treatment during the initial months of chemotherapy might have prevented disease progression in these cases. Routine screening of paediatric oncology patients for latent TB infection and exclusion of active disease prior to initiation of cancer therapy might be indicated in TB-endemic areas.