Lege Artis Medicinae

[TRAVEL MEDICINE IN GP PRACTICE]

FELKAI Péter, KOVÁCS Erzsébet

SEPTEMBER 20, 2005

Lege Artis Medicinae - 2005;15(08-09)

[The authors describe the basic ideas of travel medicine, as a newly introduced interdiscipline of the medical science in Hungary. Recently, this segment is considered to be the part of Insurance Medicine, on the other hand the methods and the practice of the travel medicine is based on the other medical specialities’ knowledge. Due to the growing number of travellers in our country as well as the consequences of the joining Hungary to EU, travel medicine could play an important role in the improvement of the Hungarian travellers’ attitude to their health care status, the prevention against the emerged infectious diseases, and in the medical assistance for the international tourism. Travel medicine also a good guideline for the fit-for-travel considerations, made by the GPs. Hungary with its advantageous geographical position appears to be an excellent stopover for any medical evacuation from East European or other surrounding countries. That is why we would like to establish a first travel medicine facility in central Europe. It is expectable that the Hungarian travellers require more and more information regarding to their health care possibilities and prevention during their trip. The first authentic person is being asked by the patients’ are GPs. The GP’s tasks are: diagnosis and the treatment of travel related diseases, the pre-travel advices. All the mentioned factors are a new challenge for the GPs in Hungary.]

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[INTRODUCTION - Gastroesophageal reflux is known to cause chronic cough and it is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux disease in asthmatic patients with chronic cough, to analyse the temporal relationship between reflux events and coughing and to assess the effect of esomeprazole treatment on respiratory symptoms and lung function in these patients. PATIENTS AND METHODS - 126 asthmatic patients with chronic dry cough were studied. Diagnosis of gastroesophageal reflux disease was based on typical symptoms and the effectiveness of therapeutic test or on pH monitoring, while control group consisted of the patients without gastroesophageal reflux (negative pH results). The study group patients received the proton pump inhibitor esomeprazole (40 mg/day for three months) and standard treatment for asthma was continued. During the study pulmonary function tests (forced expiratory volume in one second and peak expiratory flow) were evaluated four times and the reflux symptom scores as well, using a questionnaire. RESULTS - The results of pH monitoring showed that 64% of cough episodes were related to acid reflux and in 91% of reflux events preceded coughing. Esomeprazole treatment (40 mg/day for three months) not only diminished gastroesophageal reflux symptoms but also improved asthma outcome measures. Baseline pulmonary function values increased significantly together with a decrease in symptom scores and the use of rescue medication. In most patients included in the extended part of the study for another three months, the dose of inhaled steroids could be reduced with sustained therapy against gastroesophageal reflux. CONCLUSION - Our data shows that reflux events preceded coughing in most cases and that treatment of gastroesophageal reflux disease caused an improvement in different outcome measures of asthma suggest that gastroesophageal reflux disease worsens asthma and its treatment is of clinical importance in the effective management of these patients.]

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