Asthma

Focal, painless discoloration of theleft thumbnail (A) developed severalyears earlier in this 46-year-old man.Oral antifungal therapy had no effecton the lesion.

A 35-year-old man presents with extensiveplaques over much of thetrunk and extremities. This severeflare of psoriasis developed after astressful emotional experience.

A 60-year-old man with a long historyof psoriasis vulgaris required a systemiccorticosteroid for a severe exacerbationof asthma. Soon after theErythrodermic or Pustular Psoriasiscorticosteroid was discontinued, generalizederythema and scaling of theskin developed.

ABSTRACT: Indications for pulmonary function tests (PFTs) have widened substantially, ranging from screening smokers for early lung disease to determining the diagnosis and prognosis of pulmonary conditions. Current indications also include screening for drug-induced lung toxicity and preoperative screening for lung resection surgery. In the workup of respiratory symptoms, such as dyspnea, cough, and wheezing, PFTs can identify obstructive or restrictive patterns that may suggest a diagnosis such as asthma or interstitial lung disease. The ratio of FEV1 to forced vital capacity is very sensitive to the presence of airflow limitation, although bronchoprovocation testing may be needed to diagnose asthma, especially in patients with mild intermittent disease. Measurements of lung volumes and carbon monoxide-diffusing capacity (DLCO) provide crucial information in selected patients. For example, a reduced DLCO may be a sign of more advanced disease, such as emphysema or pulmonary hypertension.Since the first description of the spirometer by John Hutchinson in the late 1800s, pulmonary function tests (PFTs) have expanded to include spirometry; lung volumes; carbon monoxide-diffusing capacity (DLCO) (transfer factor); respiratory muscle performance; and exercise and functional testing, such as the 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET).

How critical-and cost-effective-is in-officepulmonary function equipment for the primarycare practitioner?

To detect wheezing during forcedexpiration in patients with dyspnea,asthma, or reactive airway disease,ask the patient to take a big breathand exhale as if he or she were blowingout the candles on a birthdaycake.

A 12-year-old boy with a history of atopy complained of pruritus and severe dryness of the hands. Over-the-counter moisturizers failed to resolve the condition. The patient did not wash his hands frequently and had no hobbies that exposed him to environmental irritants or allergens.

Three strategies have commonly been used for episodic migraine. In step care across attacks, the least expensive medications are tried for several episodes. If these fail, treatment is "stepped up" to specific agents.

For 2 months, a 31-year-old woman had had dyspnea anddull, continuous retrosternal pain. She was admitted to thehospital, and a helical CT scan of the thorax identified asaddle pulmonary embolism. An ultrasonogram revealeddeep venous thrombosis (DVT) in the left leg. Intravenousheparin was given; the patient was discharged,and warfarin was prescribed.