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.

Randomized trials of triple therapy including an inhaled corticosteroid (ICS) for chronic obstructive pulmonary disease (COPD) reported remarkable benefits on mortality compared with dual bronchodilators, likely resulting from ICS withdrawal at randomization. We compared triple therapy with dual bronchodilator combinations on major COPD outcomes in a real-world clinical practice setting. We identified a cohort of COPD patients, age 50 or older, treated during 2002-2018, from the United Kingdom's Clinical Practice Research Datalink. Patients initiating treatment with a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA) and an ICS on the same day, were compared with patients initiating a LAMA and LABA, weighted by fine stratification of propensity scores. Subjects were followed-up one year for all-cause mortality, severe exacerbation and pneumonia. The cohort included 117,729 new-users of LAMA-LABA-ICS and 26,666 of LAMA-LABA. The adjusted hazard ratio (HR) of all-cause mortality with LAMA-LABA-ICS compared with LAMA-LABA was 1.17 (95% CI: 1.04-1.31) while for severe exacerbation and pneumonia it was 1.19 (1.08-1.32) and 1.29 (1.16-1.45) respectively. However, mortality was not elevated with triple therapy among patients with asthma diagnosis (HR 0.99; 95% CI: 0.74-1.34), with two or more prior exacerbations (HR 0.88; 95% CI: 0.70-1.11), and with FEV1 percent predicted >30%. In a real-world setting of COPD treatment, triple therapy initiation was not more effective than dual bronchodilators at preventing all-cause mortality and severe COPD exacerbations. Triple therapy may be unsafe among patients without prior exacerbations, in whom ICS are not recommended, with no asthma diagnosis and with very severe airflow obstruction.

Triple Inhaler versus Dual Bronchodilator Therapy in COPD: Real-World Effectiveness on Mortality.

BACKGROUND: Early life events may have long term consequences on respiratory health including the risk of developing asthma.

/pdf/birthweight-and-preterm-birth-in-relation-to-indicators-of-4lgpgvbmoy.pdf

Birthweight and preterm birth in relation to indicators of childhood asthma

While weekend hospital admissions are associated with higher mortality, the effects of weekend hospital stays are not known. We assessed whether patients hospitalised for chronic obstructive pulmonary disease (COPD) or pneumonia have higher mortality during weekend and Friday stays. Our cohort consisted of all hospitalisations for COPD or pneumonia during 1990-2007 from the healthcare databases of the province of Quebec, Canada. The hazard ratio (HR) of in-patient death associated with Friday and weekend stay was estimated by the Cox model with time-dependent covariates, adjusted for age, sex and comorbidity. The cohort included 323 895 hospitalisations for COPD or pneumonia during which 32 414 deaths occurred (rate of death 8.06 per 1000 per day). Mortality was higher for weekend (HR 1.06, 95% CI 1.03-1.09) but not Friday admissions (HR 0.97, 95% CI 0.95-1.00), relative to Monday-Thursday admissions. Independently of the admission day, mortality was higher during weekend stays (HR 1.07, 95% CI 1.04-1.09) and Friday stays (HR 1.05, 95% CI 1.02-1.08), relative to Monday-Thursday stays. Patients hospitalised for COPD or pneumonia are at increased risk of death when staying over on a Friday or a weekend. The additional 40-56 deaths per 100 000 patients staying in hospital on those days are most likely due to reduced access to healthcare at that time.

https://erj.ersjournals.com/content/erj/44/3/627.full.pdf

Friday and weekend hospital stays: effects on mortality.

BACKGROUND: The Health and Social Survey of Quebec Children and Youth, conducted on representative samples of children nine, 13 and 16 years of age, provided data on the prevalence and determinants of asthma and allergic rhinitis in Quebec

/pdf/asthma-and-allergic-rhinitis-in-quebec-children-1fummbjc4y.pdf

Asthma and allergic rhinitis in Quebec children.

Louis-Philippe Boulet MD FRCPC 1 , Allan Becker MD FRCPC 2 , Denis Berube MD FRCPC 3 , Pierre Ernst MD FRCPC 4 , Robert Beveridge MD FRCPC 5 . Asthma Consensus Conference Editorial Committee 1 Centre de pneumologie, Institut de cardiologie et de pneumologie de l’Universite Laval, Hopital Laval, Sainte-Foy, Quebec; 2 Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba; 3 Service de pneumologie, Hopital Sainte-Justine, Montreal; 4 Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec; 5 Atlantic Health Sciences Corporation, Saint John, New Brunswick

/pdf/1998-revision-of-the-canadian-asthma-consensus-guidelines-1b98otklcb.pdf

Pierre Ernst

Papers

Triple Inhaler versus Dual Bronchodilator Therapy in COPD: Real-World Effectiveness on Mortality.

Birthweight and preterm birth in relation to indicators of childhood asthma

Friday and weekend hospital stays: effects on mortality.

Asthma and allergic rhinitis in Quebec children.

1998 Revision of the Canadian Asthma Consensus Guidelines