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.

For a long time, superoxide generation by an NADPH oxidase was considered as an oddity only found in professional phagocytes. Over the last years, six homologs of the cytochrome subunit of the phag...

/pdf/the-nox-family-of-ros-generating-nadph-oxidases-physiology-zjc88zvh59.pdf

The NOX Family of ROS-Generating NADPH Oxidases: Physiology and Pathophysiology

Prospective Cohort Study

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

In 2004, the first American Heart Association scientific statement on “Air Pollution and Cardiovascular Disease” concluded that exposure to particulate matter (PM) air pollution contributes to card...

https://cdr.lib.unc.edu/downloads/p2676x621

Particulate Matter Air Pollution and Cardiovascular Disease An Update to the Scientific Statement From the American Heart Association

Background— Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2- to 3-fold. The factors responsible for this association remain largely unknown. Methods and Results— We analyzed data from participants, ≥50 years of age, of the Third National Health and Nutrition Examination Survey (n=6629) to determine whether C-reactive protein (CRP) and other systemic inflammatory markers are present in participants with chronic airflow obstruction and are associated with cardiac injury. Participants with severe airflow obstruction had circulating leukocyte, platelet, and fibrinogen levels that were 460/μL (95% confidence interval [CI], 30 to 890/μL), 39 510/μL (95% CI, 21 730 to 57 290/μL), and 41.63 mg/dL (95% CI, 19.87 to 63.39 mg/dL) higher, respectively, than in those without airflow obstruction. They were also 2.18 times (95% CI, 1.46 to 3.27) more likely to have an elevated circulating CRP level. Moderate airflow obstruction was associated with smaller but still significant...

/pdf/why-are-patients-with-chronic-obstructive-pulmonary-disease-1ff1kkn57q.pdf

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases? The Potential Role of Systemic Inflammation in Chronic Obstructive Pulmonary Disease

The Relationship Between Reduced Lung Function and Cardiovascular Mortality: A Population-Based Study and a Systematic Review of the Literature

Chronic obstructive pulmonary disease and other disorders, associated with reduced lung function, are strong risk factors for cardiovascular events, independent of smoking. Overall, when the lowest quintile of lung function, as measured by FEV1 is compared with the highest quintile, the risk of cardiovascular mortality increases by approximately 75% in both men and women. Having symptoms of chronic bronchitis alone increases the risk of coronary deaths by 50%. Reduced ratio of FEV1 to FVC by itself is a modest independent risk factor for coronary events, increasing the risk by 30%. However, if patients have ventricular arrhythmias, the risk of coronary events is increased twofold, suggesting that the cardiotoxic effects of obstructive airways disease are amplified in those who have underlying cardiac rhythm disturbances. In general, for every 10% decrease in FEV1, all-cause mortality increases by 14%, cardiovascular mortality increases by 28%, and nonfatal coronary event increases by almost 20%. These data indicate that chronic obstructive pulmonary disease is a powerful, independent risk factor for cardiovascular morbidity and mortality.

https://www.atsjournals.org/doi/pdf/10.1513/pats.200404-032MS

Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality.

ContextThe care of patients with chronic obstructive pulmonary disease (COPD)
has changed radically over the past 2 decades, and novel therapies can not
only improve the health status of patients with COPD but also modify its natural
course.ObjectiveTo systematically review the impact of long-acting bronchodilators,
inhaled corticosteroids, nocturnal noninvasive mechanical ventilation, pulmonary
rehabilitation, domiciliary oxygen therapy, and disease management programs
on clinical outcomes in patients with COPD.Data SourcesMEDLINE and Cochrane databases were searched to identify all randomized
controlled trials and systematic reviews from 1980 to May 2002 evaluating
interventions in patients with COPD. We also hand searched bibliographies
of relevant articles and contacted experts in the field.Study Selection and Data ExtractionWe included randomized controlled trials that had follow-up of at least
3 months and contained data on at least 1 of these clinical outcomes: health-related
quality of life, exacerbations associated with COPD, or death. For pulmonary
rehabilitation, we included studies that had a follow-up of at least 6 weeks.
Using standard meta-analytic techniques, the effects of interventions were
compared with placebo or with usual care. In secondary analyses, the effects
of interventions were compared against each other, where possible.Data SynthesisLong-acting β2-agonists and anticholinergics (tiotropium)
reduced exacerbation rates by approximately 20% to 25% (relative risk [RR]
for long-acting β2-agonists, 0.79; 95% CI, 0.69-0.90; RR for
tiotropium, 0.74; 95% CI, 0.62-0.89) in patients with moderate to severe COPD.
Inhaled corticosteroids also reduced exacerbation rates by a similar amount
(RR, 0.76; 95% CI, 0.72-0.80). The beneficial effects were most pronounced
in trials enrolling patients with FEV1 between 1 L and 2 L. Combining
a long-acting β2-agonist with an inhaled corticosteroid resulted
in an approximate 30% (RR, 0.70; 95% CI, 0.62-0.78) reduction in exacerbations.
Pulmonary rehabilitation improved the health status of patients with moderate
to severe disease, but no material effect was observed on long-term survival
or hospitalization rates. Domiciliary oxygen therapy improved survival by
approximately 40% in patients with PaO2 lower than 60 mm Hg, but
not in those without hypoxia at rest. The data on disease management programs
were heterogeneous, but overall no effect was observed on survival or risk
of hospitalization. Noninvasive mechanical ventilation was not associated
with improved outcomes.ConclusionsA significant body of evidence supports the use of long-acting bronchodilators
and inhaled corticosteroids in reducing exacerbations in patients with moderate
to severe COPD. Domiciliary oxygen therapy is the only intervention that has
been demonstrated to prolong survival, but only in patients with resting hypoxia.

Contemporary management of chronic obstructive pulmonary disease: scientific review.

Background Previous research suggests that obesity is an important risk factor for asthma. However, since obesity can cause dyspnea through mechanisms other than airflow obstruction, diagnostic misclassification of asthma could partially account for this association. Objective To determine whether there is a relationship between obesity and airflow obstruction. Methods A total of 16 171 participants (17 years or older) from the Third National Health and Nutrition Examination Survey (NHANES III) were divided into 5 quintiles based on their body mass index (BMI) to determine the association between BMI quintile and risk of self-reported asthma, bronchodilator use, exercise performance, and airflow obstruction. Significant airflow obstruction was defined as a ratio less than 80% the predicted value of forced expiratory volume in 1 second to forced vital capacity adjusted for age, sex, and race. Results The highest BMI quintile (ie, the most obese participants) had the greatest risk of self-reported asthma (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.24-1.81), bronchodilator use (OR, 1.94; 95% CI, 1.38-2.72), and dyspnea with exertion (OR, 2.66; 95% CI, 2.35-3.00). Paradoxically, the highest BMI quintile had the lowest risk for significant airflow obstruction ( P = .001). Conclusions This study demonstrates that while obesity is a risk factor for self-reported asthma, obese participants are at a lower risk for (objective) airflow obstruction. Many more obese than nonobese participants were using bronchodilators despite a lack of objective evidence for airflow obstruction. These data suggest that mechanisms other than airflow obstruction are responsible for dyspnea genesis in obesity and that asthma might be overdiagnosed in the obese population.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/211850/ioi10487.pdf

S. F. Paul Man

Papers

Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases? The Potential Role of Systemic Inflammation in Chronic Obstructive Pulmonary Disease

The Relationship Between Reduced Lung Function and Cardiovascular Mortality: A Population-Based Study and a Systematic Review of the Literature

Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality.

Contemporary management of chronic obstructive pulmonary disease: scientific review.

Obesity Is a Risk Factor for Dyspnea but Not for Airflow Obstruction