• Asthma
• paediatric asthma
• pneumonia
• sleep apnoea

I read the latest Issue of Thorax with amusement and frustration.

I could not resist your challenge in your Editorial, ‘Pre-drainage tension’, triggered by letters from Drs Simpson and Leigh Smith1 ,2 to make a ridiculous acronym.3

My understanding of pneumothorax was that it is due to a loss of the negative intrapleural pressure that overcomes the elastic recoil of the pulmonary tissues. Once this vacuum is lost then air is free to enter the lungs or intrapleural space with impunity. The actual amounts will vary according to many factors, including the strength of elastic recoil of pulmonary tissues, exact sites of leak and depth of inspiration. Perhaps we need an engineer to explain this?

However, on first reading of the letters I was concerned that all texts on the issue including life support and trauma courses would have to be REPRINTED (Rapidly Expanding Pneumothorax Requiring Immediate Needle Thoracic Elimination to avoid Death), or worse still would Stop Casualties Receiving Appropriate Pneumothorax Procedures to Eliminate Death (SCRAPPED).

Having tried to be ridiculous I was then struck by the juxtaposition of Kevin Southern's article on cystic fibrosis screening4 and Dr Zarir Udwadia's article ‘MDR, XDR, TDR tuberculosis’.5 Both were excellent articles but their proximity raised issues of global health economics that must be addressed. Cystic fibrosis is a disease that has a very large budget, possibly larger with the advent of promising new treatments, but that affects relatively few. The tuberculosis figures from India are frightening. In the age of international travel it might be totally drug-resistant (TDR) tuberculosis that provides the West with a huge public health and mortality problem. When debating NHS reforms the impact of other healthcare systems on ours has not even been considered. Is it time to admit a national health service is not possible in the twenty-first century, but an international health service is not only possible but necessary? Is there a role for the British Thoracic Society to start public debates on these issues?

Thanks for a thought-provoking read.