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

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.

Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

/pdf/health-effects-of-fine-particulate-air-pollution-lines-that-s831sp8jap.pdf

Health effects of fine particulate air pollution: lines that connect

A strategy to understand the microbial components of the human genetic and metabolic landscape and how they contribute to normal physiology and predisposition to disease.

/pdf/the-human-microbiome-project-1armeyuv2c.pdf

The human microbiome project.

BACKGROUND: A decline in host resistance due to an alteration in diet--primarily of salt--was recently put forward as a possible explanation for rising rates of asthma. METHODS: A case-control study was conducted in participants in a prevalence survey which included 187 children with asthma (defined by prior diagnosis and/or a decline in forced expiratory volume in one second (FEV1) of > or = 10% after exercise) and 145 age and sex matched controls. Subjects were selected from 989 children aged 5-13 years attending 18 elementary schools on the island of Montreal. Usual dietary salt intake was estimated from a food frequency questionnaire administered to the mother, and a salt intake score was used to group the children into quartiles from I (lowest) to IV (highest salt intake). Bronchial hyperresponsiveness to methacholine was assessed by Yan's method. Cases and controls were combined in one group to examine the relationship of salt intake to bronchial hyperresponsiveness to methacholine. Methacholine responsiveness was expressed as a dose-response slope and ranks of dose-response slopes were used in the analysis. RESULTS: After accounting for important confounding variables, there was no association between asthma and salt intake, while methacholine dose-response slope ranks increased with increasing salt intake and methacholine responsiveness was greater in the highest quartile than in the lowest quartile of salt intake. The median dose-response slopes in % fall in FEV1 per mumol methacholine for quartiles I, II, III, and IV were 5.4, 5.9, 7.7, and 8.7. CONCLUSIONS: No association was found between asthma or exercise-induced bronchospasm and dietary salt intake. Bronchial hyperresponsiveness to methacholine did, however, appear to increase with greater salt intake, but the relevance of this association to asthma is unclear.

https://thorax.bmj.com/content/thoraxjnl/51/1/59.full.pdf

Usual dietary salt intake and asthma in children: a case-control study.

Increased glucocorticoid receptor–β expression, but not decreased histone deacetylase 2, in severe asthma

Risk of glaucoma in elderly patients treated with inhaled corticosteroids for chronic airflow obstruction.

Passive smoking and evolution of lung function in young adults. An 8-year longitudinal study.

Background: The relationship between therapy and adverse outcome in asthma is debated especially for naturally occurring situations. This is due in part to insufficient information regarding actual use of medications. Objective: This study was conducted to clarify the relationship between actual intake of anti-asthma drugs and asthma hospitalisation, considered as an outcome. Methods: A case-control study was performed. Patients hospitalised for an asthma exacerbation were matched to community controls identified in surrounding general practices. Patients were questioned to identify prior use of anti-asthma medications, level of use of inhaled corticosteroids and attitude towards therapy. Results: Twenty-three cases and 31 matched controls were interviewed. Cases tended to have more severe asthma than controls, as judged by more frequent use of oral corticosteroids. Cases tended to make more frequent use of oral xanthines and inhaled anticholinergics, but the proportion of patients using inhaled β2-adrenoceptor agonists and inhaled corticosteroids was similar in both groups. Use of lower doses of inhaled corticosteroids was associated with an increased risk of hospitalisation, while higher dosage was associated with␣decreased risk. Cases and controls differed as to their answers to a questionnaire concerning attitudes: cases expressed less interest in optimal usage of inhaled␣corticosteroids than controls; they also expressed more confidence in inhaled β2-agonists. When both risks were combined, overconfidence in β2-agonists and suboptimal use of inhaled steroids, the relationship with hospitalisation was significant (OR 5.5, 95% CI 1.1; 26.1). Conclusion: The results suggest that patients' attitudes to inhaled corticosteroids and actual consumption of these medications are directly related to adverse outcome in asthma.

Pierre Ernst

Papers

Usual dietary salt intake and asthma in children: a case-control study.

Increased glucocorticoid receptor–β expression, but not decreased histone deacetylase 2, in severe asthma

Risk of glaucoma in elderly patients treated with inhaled corticosteroids for chronic airflow obstruction.

Passive smoking and evolution of lung function in young adults. An 8-year longitudinal study.

Actual use of inhaled corticosteroids and risk of hospitalisation: a case-control study.