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).

Conflict of Interest Statement: F.R.K. has attended five advisory boards for SanofiAventis in the past 3 years, for which he received about $15,000; he gives CME talks on the use of Taxotere in lung cancer and head and neck cancer; he has research grants from Sanofi-Aventis, Genentech, and Novartis. J.R. serves on a safety review board for Genzyme and received $70,000 from Intermune (2006, 2007) and $50,000 from Actelion in support of research conducted in clinical trials.

BMPR2 mutation and outcome in pulmonary arterial hypertension: clinical relevance to physicians and patients.

The term cor pulmonale has traditionally been used as a synonym for right heart failure due to chronic respiratory diseases, although this condition is less frequently seen in the modern era because of the use of long-term oxygen therapy along with aggressive measures directed at optimizing ventilation and gas exchange. The mechanisms by which adaptation or maladaptation of right heart structure and function in the broader setting of pulmonary vascular disease, either intrinsic to the pulmonary circulation or due to respiratory diseases, have garnered considerable interest along with the development of medical and surgical treatments for pulmonary hypertension. Thus, the right heart is no longer considered an "innocent bystander" in pulmonary hypertension, but rather a key component in its pathophysiology. Furthermore, the status of right heart function is a major determinant of outcome. Accordingly, the right heart has become a potential, appealing target for novel therapies to treat hypertensive pulmonary vascular disease.

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201710-772KV

Cor Pulmonale Revisited. From Ferrer and Harvey to the Present

Guía de práctica clínica para el diagnóstico y tratamiento de la hipertensión pulmonar1

The updated management of PAH patients is leading to improvements in quality of life and outcome http://ow.ly/TAvMf

https://err.ersjournals.com/content/errev/24/138/550.full.pdf

Improving patient outcomes in pulmonary hypertension

At the end of 2013 clinicians managing pulmonary arterial hypertension (PAH) patients have many more treatment options available to them than they did two decades ago. Basic and clinical research continue to expand treatment options but, in a changing PAH environment, there is a need to move away from trials with primary end-points that merely demonstrate short-term improvements in function to large scale trials utilising robust end-points that reflect long-term morbidity and mortality [1].

The reviews in this issue of the European Respiratory Review discuss this evolution of study design and management of patients with PAH. The authors, all experts in the field of pulmonary hypertension, delivered the presentations upon which the articles are based at the 12th International Pulmonary Hypertension Forum in April 2013 in Hamburg, Germany. This annual platform for the exchange of knowledge and experience among clinicians and researchers was attended by over 1000 healthcare professionals from all over the world, highlighting the continuing interest in PAH.

All oral therapies currently available for the management of PAH have been approved based on change in 6-min walk distance (6MWD) over a short 12–16-week study period [2–6]. The 6MWD is a simple, inexpensive, reproducible test that has allowed the rapid expansion of therapeutic options in PAH, and remains a valuable, clinically important measure of symptomatic improvement. However, in today's more advanced PAH field, its utility as a primary end-point has been challenged. In their review, Gaine and Simonneau [7] will discuss the limitations of the 6MWD, including its reduced sensitivity in patients with milder disease [8] and the reduced ability to detect a treatment …

https://err.ersjournals.com/content/errev/22/130/423.full.pdf

Lewis J. Rubin

Papers

BMPR2 mutation and outcome in pulmonary arterial hypertension: clinical relevance to physicians and patients.

Cor Pulmonale Revisited. From Ferrer and Harvey to the Present

Guía de práctica clínica para el diagnóstico y tratamiento de la hipertensión pulmonar1

Improving patient outcomes in pulmonary hypertension

A paradigm shift in pulmonary arterial hypertension management