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).

Treprostinil Administered Using a Fully Implantable Programmable Intravascular Delivery System: Results of the Delivery for PAH Trial

BACKGROUND: Bosentan, an oral dual endothelin receptor antagonist, is indicated for use in patients with functional class (FC) III and IV pulmonary arterial hypertension (PAH). The aim of this open...

Abstract 2765: Maintenance of Improvement in 6-Minute Walk Distance with Long Term Bosentan Treatment: Results of the BREATHE-1 Open-Label Extension Study

Since the National Institutes of Health–sponsored registry on Primary Pulmonary Hypertension first comprehensively described its demographics, clinical features, and prognosis in the era preceding the introduction of targeted therapies,1 several large regional registries have provided incremental insight into the natural history of pulmonary arterial hypertension (PAH), both idiopathic and attributable to a variety of etiologies.2,3 Although these registries have yielded important information regarding the predictors of survival at the time of diagnosis, they have provided only limited insight into the impact of PAH-targeted therapies on long-term outcomes, information that is important for physicians to assess responses to therapy and guide future management. In this issue of Circulation, Weatherald and colleagues4 bridge this knowledge gap by showing that assessing hemodynamic variables after the initiation of therapy is more meaningful in determining prognosis than are baseline values. Using the database from the French Pulmonary Artery Hypertension Network Registry, a national, multicenter collaborative effort, Weatherald et al analyzed incident cases of idiopathic PAH, heritable PAH, and drug/toxin-induced PAH seen between 2006 and 2016, a period when several PAH-targeted therapies were available and others were under development. Hemodynamic parameters at diagnosis and first follow-up (averaging 4.6 months) were analyzed for their prognostic predictive value. Weatherald and colleagues provide us with a sobering reminder that we are still seeing patients with PAH late in the course of their condition, when medical therapies may be less effective. Consistent with experience from other registries, their patients had indicators of advanced disease at diagnosis: 75% had World Health Organization functional class III or IV symptoms, and the mean 6-minute walk test was 319 m; 3-year survival was 73% despite treatment with oral monotherapy in 46%, dual oral therapy in 30%, and triple therapy in 5% of patients. The key findings in this article are (1) that follow-up but not baseline hemodynamic variables were predictive of prognosis, and (2) that 2 variables that reflect right ventricular function, stroke volume index, and right atrial pressure at followup were the strongest hemodynamic predictors of outcome. Stroke volume index discriminated between better or worse survival even in patients with a low-risk profile (functional class I and II, 6-minute walk >440 m, and cardiac index >2.5 L·min–1·m–2). In addition, using receiver operating characteristics analyses, they identified follow-up hemodynamic threshold values for stroke volume index (38 mL·min–1·m–2) and right atrial pressure (9 mm Hg) that may be useful as treatment goals. © 2018 American Heart Association, Inc.

Lewis J. Rubin

Papers

Treprostinil Administered Using a Fully Implantable Programmable Intravascular Delivery System: Results of the Delivery for PAH Trial

Abstract 2765: Maintenance of Improvement in 6-Minute Walk Distance with Long Term Bosentan Treatment: Results of the BREATHE-1 Open-Label Extension Study

Assessing Prognosis of Pulmonary Arterial Hypertension in the Therapeutic Era: Importance of Serial Hemodynamic Measurements.

Inhaled Sodium Nitrite: Results Of Multiple Ascending Dose Studies Including Pharmacodynamic Interaction With Sildenafil In Normal Healthy Volunteers

Kronik tromboembolik pulmoner hipertansiyon