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.

The purpose of this study was to examine the relation between development of respiratory symptoms and the rate of change in ventilatory lung function in young adults during a study period of 8 yr. The study population consisted of 391 subjects who were 15 to 40 yr of age at initial examination, when they underwent spirometry and an interviewer-administered ATS-DLD-78-A questionnaire on respiratory health, and who were reexamined 8 yr later. The association between the development of symptoms and the rate of change in FEV1 over time (δFEV1 ml/yr) was studied in a linear regression model that included the potential confounders and other determinants of the outcome. The presence of modification by such factors as smoking, childhood exposure to environmental tobacco smoke, gender, or atopy was assessed by the significance of interaction terms between potential modifiers and incident symptoms. Subjects who developed wheezing and dyspnea and in whom a doctor diagnosed asthma had a significantly greater average ...

Respiratory symptoms in young adults should not be overlooked.

Although there are published data concerning reader variability in the assessment of parenchymal pneumoconiotic changes using the ILO Classification of Radiographs, nothing has been published on reader variability with regard to pleural abnormalities. Therefore, in the context of an epidemiologic study, we assessed between- and within-reader variability in the reading of chest radiographs for pleural abnormality using the ILO 1980 International Classification of Radiographs of Pneumoconioses. Chest radiographs of 182 insulation workers interspersed with 24 subjects without documented exposure to asbestos were assembled and read blindly by two readers, reading separately on two occasions, 1 week apart. The results of this study suggest that confident separation of pleural plaques and diffuse pleural thickening may be difficult to achieve using the present guidelines of the ILO 1980 classification. In the evaluation of the width of chest wall pleural abnormality, within-reader agreement improves as the width increases, while between-reader agreement was much less satisfactory. Excellent agreement is obtained in the evaluation of other sites, especially costophrenic angle obliteration and the presence of pleural calcification.

Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses

The purpose of this study was to estimate relationships between asthma control and hospital contacts (visits to emergency rooms and hospitalizations) in a group of patients suffering from persistent asthma, after adjustment for prior use of inhaled corticosteroids. A computerized family practice database was used to identify patients (aged 6–50 years) with persistent asthma who received asthma therapy from January 1995. The database provided information on patient demographics and drug therapy. Asthma control was estimated by a survey of patients at the end of a 12-month study period. Frequency of hospital contacts during the study period was related to demographics, asthma control, and prescribed doses of inhaled corticosteroids during a prestudy period. Review of computerized medical files of 497 family practice physicians identified 1966 patients with persistent asthma who met the study criteria. Of these patients, 1251 completed the survey (63.6%). Asthma control was assessed in 1130 patients; it was ...

Level of control and hospital contacts in persistent asthma.

Purpose
The United Kingdom (UK) government changed the prescription policy of statins, making low-dose simvastatin (10 mg) available as an over-the-counter (OTC) drug in August 2004. We assessed the impact of this policy change on statin prescribing.

Methods
We examined all statin prescriptions in the General Practice Research Database (GPRD), a well-validated database of approximately 3.5 million patients, from the first quarter of 2001 to the second quarter of 2005.

Results
From 2001, the number of statin prescriptions written for GPRD patients was increasing by approximately 437 prescriptions per 100,000 people per quarter until the time of the policy change. Over the four quarters post-policy implementation, however, this trend changed abruptly (p < 0.0001) with a decrease of 281 prescriptions per 100,000 people per quarter. This decrease was not restricted to prescriptions of 10 mg statins but was also observed for statin prescriptions of ≥20 mg. Several other cardiovascular medications displayed a similar trend as that observed in the number of statin prescriptions. This trend was not observed among non-cardiovascular control medications.

Conclusions
Our study suggests that the policy allowing the OTC sale of 10 mg simvastatin has had a significant impact on statin prescriptions by general practitioners. However, this new policy may also be leading to less aggressive statin therapy. An alternative explanation for the observed decrease in statin prescriptions may be related to the unknown factors responsible for the overall decrease observed with other cardiovascular prescription drugs. Copyright © 2006 John Wiley & Sons, Ltd.

The impact of over-the-counter simvastatin on the number of statin prescriptions in the United Kingdom: a view from the General Practice Research Database.

Health selection within a workforce has been found in several industries and appears to be more pronounced in dustier occupations. In this study of airway disease among workers exposed to asbestos and man made mineral fibres, 215 of 246 construction insulators 50 years old or less and currently working in the Montreal area were examined. Spirometry was completed successfully in 214 workers without known asbestosis and 207 underwent methacholine bronchoprovocation testing. Airway responsiveness was expressed as PC15, the concentration of methacholine causing a 15% fall in the forced expiratory volume in one second (FEV1). Exposure to asbestos and synthetic mineral fibre dust was estimated from the total hours of work in the trade since first employment. After the effect of age, height, and pack years of smoking had been taken into account, no relation was found between hours of work and any indices obtained from the forced expiratory manoeuvre (FEV1/FVC, MMF). After the effect of airway calibre (FEV1/FVC), age, and pack years of cigarette consumption had been taken into account, airway responsiveness decreased as the total hours of work in the trade increased. These findings suggest that workers with greater levels of airway responsiveness are more sensitive to exposure in a dusty workplace and in consequence are less likely to continue. In studies of workforces a survivor effect of this nature will tend to weaken the relation between lung function abnormality and occupational exposure.

https://thorax.bmj.com/content/thoraxjnl/44/2/116.full.pdf

Pierre Ernst

Papers

Respiratory symptoms in young adults should not be overlooked.

Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses

Level of control and hospital contacts in persistent asthma.

The impact of over-the-counter simvastatin on the number of statin prescriptions in the United Kingdom: a view from the General Practice Research Database.

Relation of airway responsiveness to duration of work in a dusty environment.