Spirometry and obstructive lung disease in Manitoba.

Chronic obstructive pulmonary disease (COPD) carries a heavy burden for health care. The general practitioner is particularly well placed for an early diagnosis and treatment of this mainly smoking-related disorder. In order to assess their perception of COPD and the diagnostic and therapeutic means utilised, a written questionnaire containing open questions was addressed to a representative sample of 425 Belgian general practitioners. The results of this questionnaire reveal that, general practitioners usually recognise the importance of an early diagnosis of COPD and of smoking as its main risk factor. However, the diagnosis is mainly based on symptoms and clinical signs, but not so much on a systematic use of spirometry, even though the latter is usually recommended by national and international guidelines. As a result of his poor use of spirometry, the staging of the severity of COPD, on which a treatment should be based, is insufficiently known. The implementation of the GOLD (Global initiative for chronic Obstructive Lung Disease) guidelines, in particular the use of spirometry, and the correct positioning of the various treatment modalities, should enable general practitioners to fulfill their essential role in the fight against COPD.

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by similar mechanisms: airway inflammation, airway obstruction, and airway hyperresponsiveness. However, the distinction between the two obstructive diseases is not always clear. Multiple epidemiological studies demonstrate that in elderly people with obstructive airway disease, as many as half or more may have overlapping diagnoses of asthma and COPD. A COPD-Asthma overlap syndrome is defined as an airflow obstruction that is not completely reversible, accompanied by symptoms and signs of increased obstruction reversibility. For the clinical identification of overlap syndrome COPD-Asthma Spanish guidelines proposed six diagnostic criteria. The major criteria include very positive bronchodilator test [increase in forced expiratory volume in one second (FEV1) ≥15% and ≥400 ml], eosinophilia in sputum, and personal history of asthma. The minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200 ml) on two or more occasions. The overlap syndrome COPD-Asthma is associated with enhanced response to inhaled corticosteroids due to the predominance of eosinophilic bronchial inflammation.The future clinical studies and multicenter clinical trials should lead to the investigation of disease mechanisms and simultaneous development of the novel treatment.

Use of spirometry and patterns of prescribing in COPD in primary care

Use of airway epithelial cell culture to unravel the pathogenesis and study treatment in obstructive airway diseases

Commentary on Zheng Y, Yee BJ, Wong K, Grunstein R, Piper A. A pilot randomized trial comparing CPAP versus bilevel PAP spontaneous mode in the treatment of hypoventilation disorder in patients with obesity and obstructive airway disease. J Clin Sleep Med. 20XX;XX(XX):XXX-XXX. doi:10.5664/jcsm.9506.

COPD is often accompanied by other chronic diseases that are also associated with systemic inflammation, such as obesity, diabetes, and arteriosclerosis. Recent data indicate that nocturnal oxygen desaturation and coexisting metabolic syndrome are related to systemic inflammation in patients with COPD. Alveolar hypoxia and consequent hypoxemia increase in prevalence as COPD severity increases. Chronic hypoxemia contributes to the development of adverse sequelae of COPD, such as pulmonary hypertension, atherosclerosis, lung microbiome diversity and systemic inflammation. COPD is a heterogeneous disease with airway inflammation driven by bacterial infections, few studies to date they examined microbiology or infection. The introduction of cultureindependent techniques for the microbiological analysis of respiratory samples confirmed that respiratory system hosts a large number of microorganisms, which include a wide range of bacteria. Regular exposure to tobacco smoke, lifestyle and food pattern can change the microbiome in healthy smokers and at-risk COPD patients, increasing the presence of a limited number of genres that reach a high relative abundance, a pattern, which can be considered as a dysbiosis. We assume that in patients with COPD and concurrent obesity and lung dysbiosis at least three factors play a role in the systemic inflammatory syndrome. Recent data showed that changes in the lung microbiome are associated with numerous exacerbations of COPD and are involved in mediating inflammatory responses of the host in some patients. Further research should elucidate the complex relationship between obstructive lung disease, obesity and lung microbiome diversity systemic inflammation accompanying these different conditions, and the causative role of systemic inflammation in obese COPD with nocturnal oxygen desaturation.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US population. An area of improvement hinges on early detection and proper monitoring. Spirometry is an important interventional tool; its underuse among hospitalized patients with COPD could affect quality of care. This study evaluates spirometry use at the Community Medical Center-Sierra in hospitalized patients with COPD. A retrospective medical record review from January 1, 2000, to March 15, 2002, assesses 1507 inpatients with COPD. The effects are analyzed of age, sex, race/ethnicity, diagnosis, insurance status, disposition, and admitting service on spirometry use by physicians are analyzed. A questionnaire is used to evaluate the knowledge, attitudes, and behaviors of residents toward spirometry ordering. Baseline characteristics are similar between study groups. Only 3% of 1476 study patients have spirometry performed within the recommended time frame, and only 12.2% have at least 1 spirometry performed. Patients having a primary diagnosis of COPD have a greater likelihood of having spirometry performed (20.3% vs 11.1%, P < .001), as do patients who are discharged to home (13.4% vs 5.9%, P = .001). No significant effects are noted for sex, race/ethnicity, insurance status, or admitting service. The house staff surveys reveal that most do not know the indications for (72.0%) or how to order (46.0%) spirometry. Spirometry is underused among physicians who treat hospitalized patients with COPD. Future educational efforts aimed at improving physicians' ordering and use of spirometry are needed to address this disparity.

Bronchodilatory effects of NVA237, a once daily long-acting muscarinic antagonist, in COPD patients

Targeted Deletion of Jun/AP-1 in Alveolar Epithelial Cells Causes Progressive Emphysema and Worsens Cigarette Smoke–Induced Lung Inflammation

¿Se puede utilizar la determinación del pico flujo de tos para valorar la capacidad tusígena en enfermedades respiratorias obstructivas graves?

Prediction of Maximal Exercise Capacity in Obstructive and Restrictive Pulmonary Disease

Chronic obstructive pulmonary disease prevalence in Lisbon, Portugal: The burden of obstructive lung disease study

Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients.

Chronic obstructive pulmonary disease (COPD) is a slowly progressive and poorly reversible airway obstruction disease. It is caused either alone or in combination of emphysema, chronic bronchitis (CB), and small airways disease. COPD is thought to be a multi-factorial disorder in which genetic susceptibility, environmental factors and tobacco exposure could be doubly or simultaneously implicated. Available medicines against COPD include anti-inflammatory drugs, such as β2-agonists and anticholinergics, which efficiently reduce airflow limitation but are unable to avert disease progression and mortality. Advanced glycation end products (AGE) and their receptors i.e. receptor for advanced glycation end products (RAGE) are some molecules that have been implicated in the complication of COPD. Several RAGE single nucleotide polymorphic (SNP) variants are produced by the mammalian cells. Based on the ethnicity some SNPs aggravate the COPD severity. Mammalian cells produce several alternative RAGE splice variants including a soluble RAGE (sRAGE) and an endogenous soluble RAGE (esRAGE). Both of these act as decoy receptor and thus may help to arrest the COPD complications. Several lines of evidences indicate a decreased level of sRAGE in the COPD subjects. One of the new strategies to reduce COPD complication may be sRAGE therapeutic administration to the COPD subjects. This comprehensive discussion sheds light on the role of RAGE and its polymorphic variants in the COPD complication along with sRAGE therapeutic significance in the COPD prevention.

Estimation of out of pocket direct and indirect medical expenditure and spending burden ratio across income quintiles in urban Lucknow, India