[Chronic respiratory insufficiency in general practice].

Abstract

The clinical entity of chronic respiratory insufficiency involves a variety of lung diseases with different etiology. Diagnosis, treatment and follow-up are mainly a problem of ambulatory medicine. The most common representative is the patient with chronic obstructive lung disease. The wide array of diagnostic tools makes the selection of appropriate tests difficult for the general practitioner. The clinical findings, as the most important aspect, together with a simple spirometric test (VC and FEV1), however, provide the physician with sufficient parameters to evaluate the current status. Blood gas analysis are indispenable, but can be performed at lengthy intervals. The main therapy relies on selective beta-agonists in combination with steroids. For long-term administration of steroids, however, inhaled steroids should be preferred. Antibiotics should be used liberally and without delay. Cardiac therapy is an important cornerstone in the treatment of chronic respiratory insufficiency. The frequency of glycoside intolerance makes diuretics the ideally suited drug for treatment of concomitant cardiac insufficiency. It is advantageous to use consistent inhalation therapy for drug administration, mainly due to the milder systemic side-effects. A choice must be made between the simple electric nebulizer or the more demanding IPPB-respirator, which requires more demanding patient selection. Both types can be leased through Cantonal institutions, which also provide for regular control of inhalation techniques and maintenance of the inhalation devices. Physiotherapy plays an important part in the instruction of patients as well as providing them with psychological assistance and support in everyday problems. Regular monthly controls by a physician with a standardized questionnaire have proven most useful in guiding the patients and adjusting therapy to individual needs. The frequency of hospitalization can only be reduced by observing all the above mentioned factors.