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.

The metabolic syndrome has received increased attention in the past few years. This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.

The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors —that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).1 Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus. Another set of conditions, the underlying risk factors , give rise to the metabolic risk factors. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria to be used in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general they include a combination of both underlying and metabolic risk factors.

The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to which components of the syndrome are …

https://www.lipidcenter.com/pdf/metabolic.pdf

Diagnosis and Management of the Metabolic Syndrome An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

Meeting the GOLD Standard: COPD Treatment in the UK Today

The role of venovenous extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory distress syndrome (ARDS) has been assessed by randomized controlled trials, meta-analyses

https://doi.org/10.1164/rccm.202204-0688ed

Understanding the People Excluded from Chronic Obstructive Pulmonary Disease Clinical Trials

Introduction Baseline hyperglycaemia along with Respiratory Rate has been shown to represent a marker for mortality and failure of Non Invasive Ventilation in COPD exacerbations complicated by decompensated respiratory failure. This study aims to determine whether the same association holds true for those COPD exacerbations admitted to hospital in the absence of respiratory acidosis and if other markers may predict outcomes in such a population. Methodology COPD patients admitted to University Hospital Aintree with an acute exacerbation were recruited within 48 h of admission with the primary end point being 3 month mortality. Patients presenting with respiratory acidosis were excluded. Subjects underwent clinical assessment at recruitment; blood samples were drawn for Random Blood glucose (RBG), Brain Natriuretic Peptide (BNP) level (Siemens Healthcare©). Admission ECGs were analysed in order to calculate Cardiac Infarction Injury Score (CIIS). Results 116 patients (mean age 70 years; 55% female; FEV1 0.98(predicted 2.49) litres; admission ABGS pH 7.40; PCO2 5.93kPA; PO2 9.04kPA) were recruited; 18 (16%) patients had died by 3 months. Hyperglycaemia (defined as RBG ≥7 mmol/l) was not associated with increased 3 month mortality (observed in 6/18 (33%) of deaths at 3 months vs 35/98(36%) of survivors; p=0.85).The Respiratory Rate (RR) measured during clinical assessment appeared to significantly higher in those who had died by 3 months (27 (SD 5) vs 24 (SD 5); p=0.048). No association was observed between those who had died by 3 months in terms of BNP levels (18.71 vs 24.22 pg/ml; p=0.48), CIIS (7.65 vs 6.25; p=0.37), age (71 vs 70 years; p=0.63), PaCO2 (6.29 vs 5.87 kPA) or serum Bicarbonate (25 vs 26 mmol/l; p=0.64). An inverse correlation was noted between BNP values and admission PaCO2 levels (Correlation coefficient −0.25; p=0.018) and Bicarbonate levels (Correlation coefficient −0.35; p=0.001); a positive correlation was observed between BNP levels and patient age (Correlation coefficient −0.35; p=0.002). Discussion In patients admitted to hospital with COPD exacerbations, hyperglycaemia, BNP level and CIIS were not found to be predictors of mortality in the absence of acute respiratory acidosis. Interestingly, Respiratory Rate measured whilst in hospital appears to predict outcome at 3 months.

https://thorax.bmj.com/content/thoraxjnl/65/Suppl_4/A75.1.full.pdf

S166 The role of clinical, metabolic and cardiac biomarkers in predicting outcome from COPD exacerbations requiring hospital admission: A prospective observational study

Peter M.A. Calverley

Papers

Meeting the GOLD Standard: COPD Treatment in the UK Today

Understanding the People Excluded from Chronic Obstructive Pulmonary Disease Clinical Trials

S166 The role of clinical, metabolic and cardiac biomarkers in predicting outcome from COPD exacerbations requiring hospital admission: A prospective observational study

COPD in the time of COVID-19

Side-effects of roflumilast – Authors' reply