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.

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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 Health-related quality of life (HRQOL) is a major outcome in asthma, but the relationships among HRQOL, characteristics of asthma, type of supervision, and sociodemographic characteristics of patients have not been thoroughly explored. Objective To identify major correlates of HRQOL in a survey of patients with asthma. Methods Patients with asthma were identified by their usual caregivers, either general practitioners or respiratory physicians. In a standardized interview, data were collected on patients' sociodemographic characteristics, medical history, medical resource use in the past 12 months, and asthma QOL. Intensity of asthma therapy was evaluated from the use of inhaled controllers and oral corticosteroids in the past 12 months, and number of asthma attacks during the same period was used as an indicator of level of asthma symptoms. Results Ninety-nine patients with asthma were identified (median age, 36 years; 62.6% women). In multivariate analysis, major correlates for lower HRQOL scores were having at least 5 asthma attacks and the number of medical visits in the past 12 months ( P P = .01) and female sex ( P = .05), but not intensity of therapy, age, or type of asthma supervision (general practitioner vs respiratory physician). Conclusions In this survey, HRQOL scores seem to be primarily related to asthma symptoms, as indicated by the number of attacks experienced by the patients and the frequency of medical contacts in a previous period. The relationships among HRQOL, therapy, and the determinants of control should be investigated in prospective studies.

Correlates of quality of life in patients with asthma.

RATIONALE: OM-85 BV, an immunostimulant made from bacterial extracts, has been shown to reduce the risk of hospitalization for acute exacerbation in patients with chronic obstructive pulmonary disease, as well as to reduce the length of stay for all hospitalizations.

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Economic Impact of Using an Immunostimulating Agent to Prevent Severe Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Viral respiratory infections are the major cause of asthma exacerbations [1], while subjects with asthma are more likely to suffer significant morbidity when infected [2]. The severity and duration of respiratory insult depend on complex viral-host interactions. Abnormalities of the innate and adaptive immune response have been demonstrated in humans and in animal models of asthma [3]. These phenomena may explain the increased vulnerability of asthmatics to viral respiratory infections.

Although less common than rhinovirus, which is responsible for 33–55% of asthma exacerbations in children and adults, seasonal influenza infection is a well-recognised cause of asthma exacerbations (3–23%) [1]. Dawood et al. [4] reported on a systematic surveillance programme for influenza-related hospitalisations of children in the USA. The proportion of children with asthma during seasonal influenza was 32% from 2003 to 2009, while 44% of children hospitalised with H1N1 in 2009 had asthma. O’Riordan et al. [5], in a paediatric hospital-based series, also found asthma to be more frequent during the H1N1 influenza pandemic of 2009 than in previous years of seasonal influenza (22% versus 6%). The remarkable increase in the risk of hospital admission in asthmatics with pandemic H1N1, compared with both seasonal influenza A and rhinovirus, may be explained by a lack of adaptive immunity to the H1N1 virus in many young asthmatic patients. Children with asthma were also more likely to require intensive care unit admission during the pandemic than with seasonal influenza A (22% versus 16%) [4]. In a prospective study during the autumn of 2009, Kloepfer et al. [6] collected nasal swabs for viral identification on a weekly basis. They found that children with asthma were more likely to become infected with H1N1 than children without …

Differences between asthmatics and nonasthmatics hospitalised with influenza A infection

Pesticide exposure and asthma.

OBJECTIVE: To compare the systemic safety and efficacy of hydrofluoroalkane beclomethasone dipropionate (HFA-BDP) extra-fine aerosol 800 µg/day with chlorofluorocarbon (CFC)-BDP 1500 µg/day.

/pdf/safety-and-efficacy-of-hfa-134a-beclomethasone-dipropionate-capcobikmk.pdf

Pierre Ernst

Papers

Correlates of quality of life in patients with asthma.

Economic Impact of Using an Immunostimulating Agent to Prevent Severe Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Differences between asthmatics and nonasthmatics hospitalised with influenza A infection

Pesticide exposure and asthma.

Safety and efficacy of HFA-134a beclomethasone dipropionate extra-fine aerosol over six months.