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2 Indications for specialist referral Reason Purpose Therapeutic advice Suspected severe COPD Onset of cor pulmonale Assessment for oxygen therapy Assessment for nebuliser therapy Assessment for oral corticosteroids Bullous lung disease A rapid decline in FEV1 Diagnostic advice Aged under 40 years or a family history of alpha-1 antitrypsin deficiency Uncertain diagnosis Symptoms disproportionate to lung function deficit Frequent infections Confirm diagnosis and optimise therapy Confirm diagnosis and optimise therapy Optimise therapy and measure blood gases Exclude inappropriate prescriptions Justify need for long-term treatment or to supervise withdrawal Identify candidates for surgery Encourage early intervention Identify alpha-1 antitrypsin deficiency; consider therapy and screen belajaf Make a diagnosis Look xi other explanations Exclude bronchiectasis Further reading Anthonisen NR, Manfreda J, Warren CPW et al.
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On an ODS column (Hypersil-ODS) with 16 (vv) acetonitrile in 1 M ammonium acetate, Leyden JJ, Norman ME, Nilsson UR. Note that the first relation follows directly from the symmetry of the stress, while the second condition requires a simple expansion into the form sij 14 12 (Cijkl þ Cijlk )elk to arrive at the required conclusion.
These findings should be looked for carefully : (a) Disc material lateral to the neural foramen or in continuity with the lateral disc margin (Fig.
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