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.

Global strategy for asthma management and prevention

https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

https://openresearch-repository.anu.edu.au/bitstream/1885/164632/2/01_Bin%2bSayeed_Global%252C_regional%252C_and_national_2018.pdf

Global, regional, and national incidence, prevalence, andyears lived with disability for 354 diseases and injuries for195 countries and territories, 1990–2017: a systematicanalysis for the Global Burden of Disease Study 2017

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61729-2.pdf

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Ancient Chinese scholars believed there were two natural, complementary and contradictory forces in our universe: yin and yang (or in simplified Chinese ![Graphic][1] , in traditional Chinese ![Graphic][2] , and in pinyin (standard Mandarin romanisation) yīnyang). Yin represents the female, negative aspects, darkness, softness, moisture, night-time, even numbers, and docility. Yang represents the male, positive aspects, brightness, hardness, dryness, day-time, odd numbers, and dominance. Yin and yang are continually in a state of flux and always looking for a balance point. One moves, the other responds. Ancient scholars therefore treated this phenomenon as a natural universal law.

In this issue of the European Respiratory Journal ( ERJ ), Man et al. 1 hypothesise that a ratio of fibronectin to C-reactive protein (CRP) is a more suitable tool than each separated biomarker to assess the prognosis of chronic obstructive pulmonary disease (COPD). Using the Lung Health Study III data 2, they updated (and improved on) their previous research on CRP only 3. It appears that in this well-described group of mild-to-moderate COPD patients, the relationship of the log transformed ratio of fibronectin to CRP (both in ug·mL−1) and mortality is L shaped, …

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https://erj.ersjournals.com/content/erj/32/6/1426.full.pdf

The yin and yang of COPD: or balancing repair (yang) and inflammation (yin).

Resumen Fundamento y objetivo Las hospitalizaciones por enfermedad pulmonar obstructiva cronica (EPOC) se producen mayoritariamente en pacientes de edad avanzada. Nuestro objetivo es describir las caracteristicas y el tratamiento de los pacientes ancianos hospitalizados por EPOC en los servicios de Medicina Interna, comparados con el grupo de menor edad. Pacientes y metodo Estudio observacional, prospectivo y multicentrico. Se comparan las diferencias entre los pacientes mayores de 80 anos y el resto respecto a comorbilidad, gravedad de la EPOC, ingresos previos, dias de estancia y tratamiento prescrito. La comorbilidad se valoro mediante el indice de Charlson y un cuestionario disenado al efecto. Resultados Se incluyeron 398 sujetos, 353 de ellos varones (89%), con una edad media (DE) de 73,7 (8,8) anos, de los que 107 (26,9%) eran mayores de 80 anos. Estos pacientes tenian menor gravedad de la EPOC segun la clasificacion GOLD (p  Conclusiones Una cuarta parte de los pacientes hospitalizados por EPOC en los servicios de Medicina Interna tienen mas de 80 anos. Aunque presentan menor obstruccion, tienen un grado de disnea similar, mayor comorbilidad cardiaca y su tratamiento se ajusta menos a las recomendaciones de las guias.

Características clínicas y tratamiento de los pacientes ancianos hospitalizados por descompensación de enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna españoles Estudio ECCO

BACKGROUND Underdiagnosis of chronic obstructive pulmonary disease (COPD) is common. We aimed to assess the effectiveness of using the Chronic Obstructive Pulmonary Disease-Population Screener (COPD-PS) questionnaire with pre-bronchodilator (BD) peak expiratory flow (PEF) measurements as a case-finding strategy for COPD in primary care. METHODS This was a two-stage, cross-sectional study comprising a population survey in a primary care population aged 35 years without previous COPD, followed by a validation study using COPD-PS 4 or PEF 2.2 l/s·m2, and confirmed by spirometry (post-BD forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] <0.70). The predictive capacity of the strategy was assessed in a case-control sub-study. RESULTS Of a total of 10 071 individuals, 6969 (69.2%) participants were included. Both tests were positive in 4.3% subjects, PEF only in 2.1% and COPD-PS only in 5.1%. Of the 802 with positive screening results, COPD was confirmed using spirometry in 130, accounting for 1.9% of all participants and 16.2% of those who tested positive on COPD-PS or PEF. Among the 130 true-positives, the mean score for the COPD-PS questionnaire was 5.1 l/s·m2 (± standard deviation [SD] 1.7) and 1.9 l/s·m2 (±SD 0.8) for pre-BD PEF, both significantly worse than in the 672 false-positives. The combined use of both screening tests had a sensitivity of 67.5%, a specificity of 71.3% and a diagnostic accuracy of 69.6%. CONCLUSION Case finding for COPD using COPD-PS + PEF led to a 90% reduction in the number of spirometry tests performed.

Combining case-finding methods for COPD in primary care: a large, two-stage design study.

Introduccion: los diagnosticos de alta hospitalaria segun el Conjunto Minimo Basico de Datos (CMBD) en Espana han sido estudiados de manera limitada hasta la fecha. El estudio Recursos y Calidad en Patologia del Aparato Respiratorio (RECALAR) se focaliza en los resultados recientes del CMBD del ambito respiratorio nacional. Objetivo: analizar indicadores de eficiencia, calidad y resultados en salud de las unidades o servicios de neumologia y los referidos a las enfermedades del aparato respiratorio. Metodos: analisis de la base de datos del CMBD de diagnosticos principales respiratorios. Se agruparon por categoria y diagnostico principal, grupo etario, comunidad autonoma y servicio. Resultados: durante el periodo de 2003 a 2015, las altas hospitalarias por causa respiratoria segun el CMBD en Espana se incrementaron un 32%, alcanzando las 474.819 en 2015, con un incremento medio anual del 3,0%. Respecto a altas CMBD en adultos mayores de 15 anos, destacan un 16,2% en neumonias y un 14,2% en EPOC; en ninos, destacan las causas infecciosas, con un 18,9% de infecciones respiratorias agudas, un 18,9% de bronquiolitis y un 14,9% de neumonias. Se observaron importantes variaciones por ano, enfermedad, comunidad autonoma y servicios. Conclusion: la carga de las enfermedades respiratorias en Espana, medida por altas hospitalarias segun el CMBD, es muy elevada, y seguia creciente en 2015.

Joan B. Soriano

Papers

The yin and yang of COPD: or balancing repair (yang) and inflammation (yin).

Características clínicas y tratamiento de los pacientes ancianos hospitalizados por descompensación de enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna españoles Estudio ECCO

Combining case-finding methods for COPD in primary care: a large, two-stage design study.

Las enfermedades respiratorias en España a la luz del CMBD de RECALAR

EPOC en la vida y en la muerte