Meakins and Christie realized that many factors contributed to dyspnea and limited exercise capacity, and that to manage our patients effectively the interactions need to be understood and measured. This applies not only to their main interest, emphysema, but also to cardiac failure; Christie was in agreement with his eminent contemporary, Sir Thomas Lewis: “The first indication of cardiac failure is to be found in a diminished tolerance of exercise. Of the very numerous tests of cardiac efficiency and inefficiency that have been devised, based as they are mainly upon pulse-rate or upon blood-pressure or upon both, there is none that approach in delicacy the symptom of breathlessness”.
Nowadays if the question is asked’as to what limits patients’ capacity to exercise, the logical answer is that the same factors limit patients as healthy subjects, but at a lower level of activity and with a different weighting of contributory factors. Thus, it seems possible that the field of integrative physiology will be an increasingly fertile source of ideas and strategies in patient management. Jonathan Meakins and Ronald Christie would be glad to know that their seminal work continues to bear fruit. Visiting an online pharmacy has never been easier and safer, since now you have the one you can call your favorite one: buy levitra professional at the pharmacy that always takes care of its customers and always pay less money.
Acknowledgements: I am grateful to Dr W Thurlbeck for the photograph of Dr Christie, and to Dr Jonathan Meakins III for that of his grandfather. Our work has been supported by the Medical Research Council, the Ontario Heart and Stroke Foundation, and the Canadian and Ontario Thoracic Societies.