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.

https://journal.chestnet.org/article/S0012-3692(12)60129-9/pdf

Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

ALAT
: alanine aminotransferase
ASAT
: aspartate aminotransferase
APAH
: associated pulmonary arterial hypertension
BAS
: balloon atrial septostomy
BMPR2
: bone morphogenetic protein receptor 2
BNP
: brain natriuretic peptide
BPA
: balloon pulmonary angioplasty
BREATHE
: Bosentan

/pdf/2015-esc-ers-guidelines-for-the-diagnosis-and-treatment-of-y26yabnnom.pdf

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

TD, Potts-Kant EN, Ingram JL, Wang Y, Jung S-H, et al. Alveolar macrophages from overweight/obese subjects with asthma demonstrate a proinflammatory phenotype.Am J Respir Crit Care Med 2012;186:404–411. 7. Shore SA. Obesity and asthma: lessons from animal models. J Appl Physiol 2007;102:516–528. 8. Shore SA. Obesity, airway hyperresponsiveness, and inflammation. J Appl Physiol 2010;108:735–743. 9. Mathis D, Shoelson SE. Immunometabolism: an emerging frontier. Nat Rev Immunol 2011;11:81. 10. Osborn O, Olefsky JM. The cellular and signaling networks linking the immune system and metabolism in disease. Nat Med 2012;18:363–374. 11. Mancuso P, Gottschalk A, Phare SM, Peters-Golden M, Lukacs NW, Huffnagle GB. Leptin-deficient mice exhibit impaired host defense in gram-negative pneumonia. J Immunol 2002;168:4018–4024. 12. Mancuso P, Peters-Golden M, Goel D, Goldberg J, Brock TG, Greenwald-Yarnell M, Myers MG Jr. Disruption of leptin receptorSTAT3 signaling enhances leukotriene production and pulmonary host defense against pneumococcal pneumonia. J Immunol 2011;186: 1081–1090. 13. Sutherland ER, Goleva E, Strand M, Beuther DA, Leung DY. Body mass and glucocorticoid response in asthma. Am J Respir Crit Care Med 2008;178:682–687. 14. Sutherland ER, Goleva E, King TS, Lehman E, Stevens AD, Jackson LP, Stream AR, Fahy JV. Cluster analysis of obesity and asthma phenotypes. PLoS ONE 2012;7:e36631. 15. Williams AS, Chen L, Kasahara DI, Wurmbrand AP, Shore SA. Obesity and airway responsiveness: role of TNFR2. Pulm Pharmacol Ther 2012; Epub ahead of print. 16. Shore SA, Schwartzman IN, Mellema MS, Flynt L, Imrich A, Johnston RA. Effect of leptin on allergic airway responses in mice. J Allergy Clin Immunol 2005;115:103–109. 17. Huang K, Rabold R, Abston E, Schofield B, Misra V, Galdzicka E, Lee H, Biswal S, Mitzner W, Tankersley CG. Effects of leptin deficiency on postnatal lung development in mice. J Appl Physiol 2008;105:249–259. 18. Kirwin SM, Bhandari V, Dimatteo D, Barone C, Johnson L, Paul S, Spitzer AR, Chander A, Hassink SG, Funanage VL. Leptin enhances lung maturity in the fetal rat. Pediatr Res 2006;60:200–204. 19. Jain M, Budinger GR, Lo A, Urich D, Rivera SE, Ghosh AK, Gonzalez A, Chiarella SE, Marks K, Donnelly HK, et al. Leptin promotes fibroproliferative acute respiratory distress syndrome by inhibiting peroxisome proliferator-activated receptor-gamma. Am J Respir Crit Care Med 2011;183:1490–1498.

The 6-minute walk test in pulmonary arterial hypertension: how far is enough?

Background—Primary pulmonary hypertension (PPH) is a rare disease of unknown cause. Although PPH and secondarypulmonary hypertension (SPH) share many clinical and pathological characteristics, their origins may be disparate. Inpulmonary artery smooth muscle cells (PASMCs), the activity of voltage-gated K

Artery Smooth Muscle Cells of Patients With Primary Pulmonary Hypertension

Portopulmonary hypertension (PPHTN) is a severe and potentially fatal complication of liver disease that occurs in 5–10% of adult patients presenting for liver transplant (1). The mean survival after diagnosis of PPHTN is approximately 15 months (2). The presence of PPHTN is often considered a contraindication to liver transplantation due to significant perioperative morbidity and mortality (3). Preoperative treatment with continuous intravenous epoprostenol, a potent pulmonary vasodilator and antiproliferative agent, reduces pulmonary vascular resistance in patients with PPHTN (4), enabling liver transplantation in some adult patients (4,5,6). There have been very few previous reports of PPHTN in children with end stage liver disease and no documented reports of epoprostenol infusion as a bridge to pediatric liver transplantation. We report an 11-year-old girl with biliary atresia and severe PPHTN treated with continuous intravenous epoprostenol before undergoing a successful orthotopic liver transplant (OLT) and whose epoprostenol was weaned and discontinued 3 months after OLT.

Lewis J. Rubin

Papers

The 6-minute walk test in pulmonary arterial hypertension: how far is enough?

Artery Smooth Muscle Cells of Patients With Primary Pulmonary Hypertension

Successful liver transplantation in a child with severe portopulmonary hypertension treated with epoprostenol

Bosentan therapy for pulmonary arterial hypertension

Effects Of Inhaled Aviptadil (Vasoactive Intestinal Peptide) In Patients With Pulmonary Arterial Hypertension (PAH)