Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Chronic obstructive pulmonary disease (COPD) is a common problem in the elderly. The disease is characterised by intermittent worsening of symptoms and these episodes are called acute exacerbations. The best estimate, based on several lines of evidence, is that approximately half of all exacerbations are caused by bacteria. These lines of evidence include studies of lower respiratory tract bacteriology during exacerbations, correlation of airways’ inflammation with results of sputum cultures during exacerbations, analysis of immune responses to bacterial pathogens, and the observation in randomised, prospective, placebo-controlled trials that antibacterial therapy is of benefit. The most important bacterial causes of exacerbations of COPD are nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Chlamydia pneumoniae.

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Chronic obstructive pulmonary disease

Representatives from many countries serve as a network for the dissemination and implementation of programs for diagnosis, management, and prevention of COPD. The GOLD Board of Directors is grateful to the many GOLD National Leaders who participated in discussions of concepts that appear in GOLD reports.

Global initiative for chronic obstructive lung disease.

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

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An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.

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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary

Introduction Since the NICE guidelines in 2004 and introduction of the Quality and Outcomes Framework (QOF) in 2004, the prevalence of COPD seen in general practice has increased (Smith 2008).1 We have investigated whether this trend has continued until 2009, and explored whether this can be explained by change in mean age at diagnosis and death. Methods We identified all patients aged between 35 and 89 years (n=2 173 494, mean age =56, 49% male) in The Health Improvement Network (THIN) primary care database. From this cohort of patients we identified patients with a diagnosis of COPD using the criteria for QOF. We calculated annual incidence and prevalence rates, and mean age of patients with COPD, first COPD diagnosis and death between 2000 and 2009. Results In total, 53 379 (2.5%) of the patients were diagnosed with COPD. The prevalence of COPD increased by 50% over the 10-year period, from 24 cases per 1000 patient years in 2000 to 36 in 2009 (Abstract P213 figure 1A). However, the diagnosis of new COPD cases remained fairly constant (p=0.295), at 3.5 cases per 1000 patient years (Abstract P213 figure 1A). The mean age at first COPD diagnosis (incidence) decreased significantly (p<0.001) by 2 years and 5 months from 69 years and 1 months in 2000 to 66 years and 8 months in 2009 (Abstract P213 figure 1B). The mean age at death of COPD patients increased significantly (p=0.008) by 9 months from 76 years and 2 months in 2000 to 76 years and 11 months in 2009 (Abstract P213 figure 1B). Whereas the mean age of prevalent patients remained fairly constant (p=0.098) over the period, varying between 70 years and 70 years and 8 months (Abstract P213 figure 1B).Abstract P213 Figure 1 Conclusion We found that over the last decade, the average age of patients with COPD has remained relatively constant at around 70 years. COPD is increasingly being diagnosed at a younger age and patients are living longer, which may in part explain the 50% rise in COPD prevalence.

Longitudinal changes in the rate and mean age of incidence and prevalence of copd in the uk, 2000-2009

Introduction Chronic mucus hypersecretion (CMH) is associated with COPD development and progression. CMH presence across adult life is dynamic, influenced by factors such as smoking behaviour. CMH is usually considered a binary phenotype and the potential influence of longitudinal CMH pattern on concurrent FEV 1 decline has not been explored. We investigated how longitudinal prevalence of CMH relates to concurrent FEV 1 decline. Methods The MRC National Survey of Health and Development consists of a sample of men and women born in one week in March 1946 within England, Scotland and Wales. Smoking behaviour, MRC questionnaire defined CMH, height, weight and pre-bronchodilator spirometry were recorded at three ages: 43, 53 and (60–64) years. We used the number occasions that CMH was positively reported (0–3) as a measure of longitudinal prevalence of CMH. Multilevel models adjusted for sex were used to analyse the relationship between longitudinal prevalence of CMH and concurrent FEV 1 decline (between ages 43 and (60–64)), allowing both intercept and slope to vary according to the longitudinal prevalence of CMH score. Height, weight and mean FEV 1 at age 43 years were then included in the model. Smoking status (current, ex and never-smoker) and number of cigarettes smoked daily were included as time-varying covariates capable of influencing both intercept and slope. Results 1960 individuals contributed data to the multilevel model: 46% male; 59% ever-smoker and mean FEV 1 at age 43 years = 3.00 L. 13% reported CMH ≥ once between ages 43 and 60–64 years. After full adjustment, longitudinal prevalence of CMH was significantly associated with both a lower FEV 1 at age 43 (intercept p 1 (p = 0.003) i.e. presence of CMH on all three occasions was associated with an additional 9.6 ml/year FEV 1 decline compared with those without CMH on any occasion. Conclusion Longitudinal prevalence of CMH is associated with concurrent FEV 1 decline independent of concurrent smoking history. Rather than CMH being solely an airway disease phenotype, the longitudinal course of CMH may represent a biomarker of concurrent disease activity.

https://thorax.bmj.com/content/thoraxjnl/70/Suppl_3/A186.1.full.pdf

P217 Chronic mucus hypersecretion may represent a biomarker of airways disease activity rather than simply a phenotype: A longitudinal study of a nationally representative British birth cohort

Is exacerbation frequency related to social factors

et al. The polymeric mucin Muc5ac is required for allergic airway hyperreactivity. Nat Commun 2015;6:6281. 9. Radicioni G, Ceppe A, Ford AA, Alexis NE, Barr RG, Bleecker ER, et al. Airway mucin MUC5AC and MUC5B concentrations and the initiation and progression of chronic obstructive pulmonary disease: an analysis of the SPIROMICS cohort. Lancet Respir Med 2021;9: 1241–1254. 10. Pividori M, Schoettler N, Nicolae DL, Ober C, Im HK. Shared and distinct genetic risk factors for childhood-onset and adult-onset asthma: genome-wide and transcriptome-wide studies. Lancet Respir Med 2019;7:509–522. 11. Shrine N, Portelli MA, John C, Soler Artigas M, Bennett N, Hall R, et al. Moderate-to-severe asthma in individuals of European ancestry: a genome-wide association study. Lancet Respir Med 2019;7:20–34. 12. Okuda K, Chen G, Subramani DB, Wolf M, Gilmore RC, Kato T, et al. Localization of secretory mucins MUC5AC and MUC5B in normal/healthy human airways. Am J Respir Crit Care Med 2019;199:715–727. 13. Hoang ON, Ermund A, Jaramillo AM, Fakih D, French CB, Flores JR, et al. Mucins MUC5AC and MUC5B are variably packaged in the same and in separate secretory granules. Am J Respir Crit Care Med 2022; 206:1081–1095. 14. Kesimer M, Ehre C, Burns KA, Davis CW, Sheehan JK, Pickles RJ. Molecular organization of the mucins and glycocalyx underlying mucus transport over mucosal surfaces of the airways. Mucosal Immunol 2013;6:379–392. 15. Davis CW, Dickey BF. Regulated airway goblet cell mucin secretion. Annu Rev Physiol 2008;70:487–512.

https://doi.org/10.1164/rccm.202207-1271ed

Obesity, Insulin Resistance, and Asthma

COPD is a progressive lung disease that leads to significant impairment of quality of life and is the third leading cause of death worldwide.1 It is principally caused by tobacco smoking over many years through airway inflammation and oxidative stress to lung tissue. Patients exposed to smoke or occupational dusts are diagnosed with the disease when their post-bronchodilator FEV1/FVC ratio falls to <0.7.2 Disease severity is assessed differently by expressing the measured FEV1 as a percentage of the expected value for normal, healthy people of similar sex, age and height. The threshold value of <0.7 for the FEV1/FVC ratio is arbitrary and may not always identify people in the early stages of COPD with smoking-related lung damage.

COPD exacerbations (the flare-up of respiratory symptoms) are often triggered by viral or bacterial infection and cause patients sometimes to seek medical help. Attention has focused on those patients most susceptible to exacerbation as the disease appears to progress more rapidly in this group, and consequently, they …

https://thorax.bmj.com/content/thoraxjnl/69/8/689.full.pdf

Gavin C. Donaldson

Papers

Longitudinal changes in the rate and mean age of incidence and prevalence of copd in the uk, 2000-2009

P217 Chronic mucus hypersecretion may represent a biomarker of airways disease activity rather than simply a phenotype: A longitudinal study of a nationally representative British birth cohort

Is exacerbation frequency related to social factors

Obesity, Insulin Resistance, and Asthma

Exacerbations in non-COPD patients: recognition?