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ACHIEVEMENTS I N RESPIRATOR Y MEDICIN E Since 1974 , th e respirator y divisio n ha s bee n served by the following physicians: Dr. Donald Y.C. Yu, Dr. S.Y. So, Dr. W.K. Lam, and Dr. Mary S.M. Ip. In addition, Dr. Jane CK. Chan is completing he r 2-yea r clinica l training a t Stanford , and Dr . Georg e CY . Cha n i s no w respirator y physician-trainee and will be furthering his training abroad next year. Over these years, the lung function laboratory has continuously evolved and modernized: e.g . fro m th e wate r displacemen t spirometer (Godart Pulmotest) and Collins respirometer to the Gould 5000IV Computerized Pulmonary Functio n Test s System (plu s the Computerized Pulmonar y Exercis e Testing System), and fro m th e dr y bellow s spiromete r an d th e digital pneumotach and X-Y recorder to the portable electroni c spiromete r wit h rea l tim e tes t curve display . Improvemen t an d expansio n of our respiratory patient care during this period is also witnessed by the introduction of new diagnostic and therapeuti c facilitie s (e.g . flexible fi breoptic bronchoscopy, histamine/methacholine bronchial challenge tests, allergy work-up, computerized volume ventilators with microprocessor controlled pneumatics and patient monitoring , computerized analysis of breathing patterns, nasal continuous positiv e airway pressure systems , oxygen concentrators for domiciliary oxygen therapy, pulse oximetry an d end-tida l car bon dioxide monitoring, Nd-YAG laser therapy via fibreoptic bronchoscope, etc) and an increase of respirator y outpatien t clinic s fro m on e pe r week before 1980 to 4 per week at present (general respiratory , asthma , respirator y oncology , and bronchiectasis). Research ha s bee n a n integra l par t o f th e work of the respiratory division in these 15 years. Epidemiological studie s hav e establishe d tha t bronchial asthma (1), bronchial carcinoma (2,3), along with chroni c bronchitis and emphysem a and respiratory infections (including tuberculosis ), are common respiratory problems in Hong Kong, whereas sarcoidosi s (4 ) and asbestos-re lated diseases are relatively uncommon (5). The cumulative prevalence of asthma in adults was 0.5% (1), and research has been focussed o n the effects o f anti-asthmati c drug s t o elucidate th e pathogenesis of asthma, and the role of acupuncture . Sodium cromoglycate, a mast cell stabilizer, was foun d t o b e effectiv e i n asthm a whethe r given by powder or by aerosol (6). The latter is preferred in Hong Kong where humidity is high, and the powder often clumps. The failure of inhaled verapami l an d sublingua l nifedipin e t o protect agains t allergen-induce d asthm a (7 ) would sugges t that mechanisms other than th e calcium ion flux-dependent mediator release (8) may be involved. Similarly, the ineffectivenes s of ketanseri n ( a selectiv e 5-hydroxytryptamin e or serotonin blocking agent) on exercise-induced asthma suggeste d tha t serotoni n ha d a limite d role in it s pathogenesis (9) . More recently, air way inflammatio n wit h infiltratio n b y inflam matory cells is thought to be central in the pathogenesis of asthma (10) , and th e effectiveness o f inhaled corticosteroids has circumvented man y of the problems associated with the chronic use of systemic corticosteroids (11). The demonstration o f th e efficac y o f a twic e dail y inhalatio n regimen further simplifie d it s use (12). A recent survey of asthma therapy in Hong Kong (13) has demonstrated a significan t underus e o f paren teral steroid in acute asthma and of topical steroid in maintenance therapy among general practitioners . This deficiency i n managemen t mus t be corrected as it may be a contributing factor for the rising asthm a mortalit y i n young male s i n Hong Kong in the past decade (14). By employing the techniques of histamine bronchial challenge and radionuclide gated lung scanning for examining th e regiona l distributio n o f ventila tion during bronchoconstriction, the pathogenesis of arterial desaturation in asthma was studied (15,16). It was demonstrated tha t hypoxaemia seen in acute asthma was due to a shift of ventilation from base to apex and a reversal of normal ventilatory pattern. The role of acupuncture...

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