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

Diagnostic Criteria of Nontuberculous Mycobacterial Lung Disease Key Laboratory Features of NTM Health Careand Hygiene-associated Disease Prevention Prophylaxis and Treatment of NTM Disease Introduction Methods Taxonomy Epidemiology Pathogenesis Host Defense and Immune Defects Pulmonary Disease Body Morphotype Tumor Necrosis Factor Inhibition Laboratory Procedures Collection, Digestion, Decontamination, and Staining of Specimens Respiratory Specimens Body Fluids, Abscesses, and Tissues Blood Specimen Processing Smear Microscopy Culture Techniques Incubation of NTM Cultures NTM Identification Antimicrobial Susceptibility Testing for NTM Molecular Typing Methods of NTM Clinical Presentations and Diagnostic Criteria Pulmonary Disease Cystic Fibrosis Hypersensitivity-like Disease Transplant Recipients Disseminated Disease Lymphatic Disease Skin, Soft Tissue, and Bone Disease

/pdf/an-official-ats-idsa-statement-diagnosis-treatment-and-1jy41yfwpp.pdf

An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-2008-update-13eqfzaw4u.pdf

Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Pneumoconioses and Other Mineral Dust–Related Diseases

BACKGROUND: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking.

/pdf/inhaled-corticosteroid-therapy-does-not-control-asthma-1f9iqt204e.pdf

Inhaled corticosteroid therapy does not control asthma.

BACKGROUND: The value of other health care professionals is increasingly being recognized to compensate for the shortage of physicians in Canada. Chronic cough is one of the most common reasons for consultation with a respirologist. In the present study, a prospective, randomized, controlled study was undertaken to determine whether Certified Respiratory Educators (CREs) could manage screened patients with chronic cough as effectively as respirologists.

/pdf/assessment-and-management-of-patients-with-chronic-cough-by-56u73qmnam.pdf

Assessment and management of patients with chronic cough by Certified Respiratory Educators: a randomized controlled trial.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.

/pdf/spirometric-findings-among-school-aged-first-nations-j8bxhv1oyn.pdf

Spirometric findings among school-aged First Nations children on a reserve: A pilot study

Summary The use of short-course chemotherapy in silico­ tuberculosis in thegoldmining industry in South Africa is described in a comparative trial of 94 cases of silicotuberculosis and two matched-pair control groups with pUlmonary tuberculosis only. The theo­ retical and practical considerations of short-course· chemotherapy are discussed. It is concluded that this is an effective means of treatment for pulmonary tuberculosis in patients with silicosis as well as in patients with pulmonarytuberculosis only, irrespective of previous exposure to silica dust There are no valid reasons why the basic tenets of short-course chemo­ therapy for the treatment of pulmonary tuberculosis should not apply in silicotuberculosis. S Afr Med J 1984; 66: 327-330. Short-course chemotherapy for pulmonary tuberculosis is well establish~d as an effective form of therapy for this disease. However, there are a number of special groups of patients with pulmonary tuberculosis and concomitant diseases in which information on the results of short-course chemotherapy is of particular interest. One of these groups comprises patients with silicotuberculosis. I It has been reported that tuberculosis with silicosis responds less satisfactorily to standard chemotherapy than does tuberculosis without silicosis and that tuberculosis persists for life in patients with silicosis. Morgan2 suggests that chemotherapy (in maintenance form) should be continued indefinitely. This view has raised doubts about the efficacy of short-course chemotherapy in silicotuberculosis. This report describes the use of three short-course chemo­ therapeutic regimens in the treatment of patients with silico­ tuberculosis and patients with tuberculosis alone which has formed part of a clinical trial to evaluate this form of treatment under routine conditions in the goldmining industry in South Africa. Patients and methods Selection of patients A tuberculosis and silicosis diagnostic service is mandated by law in the goldmining industry in South Africa as these diseases are compensable industrial diseases. Each prospective employee has a chest radiograph before employment and thereafter at 6-monthly intervals. In this manner, lesions suggestive of

Robert L. Cowie

Papers

Pneumoconioses and Other Mineral Dust–Related Diseases

Inhaled corticosteroid therapy does not control asthma.

Assessment and management of patients with chronic cough by Certified Respiratory Educators: a randomized controlled trial.

Spirometric findings among school-aged First Nations children on a reserve: A pilot study

Short-course chemotherapy for silicotuberculosis.