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

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61729-2.pdf

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

List of participants (GOLD Scientific Committee): Nicholas Anthonisen, Winnipeg, Canada; William C. Bailey, Birmingham, US; Peter J. Barnes, London, UK; Tim Clark, London, UK; Leonardo Fabbri, Modena, Italy; Yoshinosuke Fukuchi, Tokyo, Japan; Lawrence Grouse, Seattle, US; James C. Hogg, Vancouver, Canada; Dirkje S. Postma, Groningen, the Netherlands; Klaus F. Rabe, Leiden, the Netherlands; Scott D. Ramsey, Seattle, US; Stephen I. Rennard, Omaha, US; Roberto Rodriguez-Roisin, Barcelona, Spain; Nikos Siafakas, Heraklion, Greece; Sean D. Sullivan, Seattle, US; Wan-Cheng Tan, Singapore; Claude Lenfant, NHLBI, Bethesda, US; Nikolai Khaltaev, WHO, Geneva, Switzerland.

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.

SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” 

Edited by V. Brusasco, R. Crapo and G. Viegi 

Number 5 in this Series 







This section is written to provide guidance in interpreting pulmonary function tests (PFTs) to medical directors of hospital-based laboratories that perform PFTs, and physicians who are responsible for interpreting the results of PFTs most commonly ordered for clinical purposes. Specifically, this section addresses the interpretation of spirometry, bronchodilator response, carbon monoxide diffusing capacity ( D L,CO) and lung volumes.

The sources of variation in lung function testing and technical aspects of spirometry, lung volume measurements and D L,CO measurement have been considered in other documents published in this series of Task Force reports 1–4 and in the American Thoracic Society (ATS) interpretative strategies document 5.

An interpretation begins with a review and comment on test quality. Tests that are less than optimal may still contain useful information, but interpreters should identify the problems and the direction and magnitude of the potential errors. Omitting the quality review and relying only on numerical results for clinical decision making is a common mistake, which is more easily made by those who are dependent upon computer interpretations.

Once quality has been assured, the next steps involve a series of comparisons 6 that include comparisons of test results with reference values based on healthy subjects 5, comparisons with known disease or abnormal physiological patterns ( i.e. obstruction and restriction), and comparisons with self, a rather formal term for evaluating change in an individual patient. A final step in the lung function report is to answer the clinical question that prompted the test.

Poor choices made during these preparatory steps increase the risk of misclassification, i.e. a falsely negative or falsely positive interpretation for a lung function abnormality or a change …

https://erj.ersjournals.com/content/erj/26/5/948.full.pdf

Interpretative strategies for lung function tests

Summary
To determine whether circulating platelets alter during asthmatic reactions induced by allergens, we studied nine subjects previously shown to develop an early or dual asthmatic reaction after inhalation challenge with extracts of house dust mite or grass pollen. In each subject, FEV1, circulating platelets and leucocytes were measured before, 15, 30 and 60 min, and 2, 4, 6 and 8 hr after inhalation of allergen and diluent control administered in a single-blind, randomized fashion. The same procedure was repeated in six of the nine subjects after bronchoconstriction induced by methacholine. Each subject developed an early asthmatic reaction after allergen inhalation challenge, which was followed by a late asthmatic reaction in six subjects and by an equivocal late asthmatic reaction in two of them (fall in FEV1 of 15 and 17% respectively). Compared with the control day, circulating platelets significantly decreased during the allergen-induced early asthmatic reaction (P < 0·025, at 30 min). Platelet counts returned to baseline values within 4 hr and remained steady thereafter both in subjects who did and did not develop a late asthmatic reaction. No changes in platelet counts occurred after bronchoconstriction induced by methacholine. Diurnal increase of leucocyte numbers occurred after challenge with both allergen and diluent control. These results suggest that platelets may be involved in the pathogenesis of allergen-induced asthmatic reactions.

Venous blood platelets decrease during allergen-induced asthmatic reactions.

The availability of non-invasive insulin delivery options for patients with diabetes may encourage earlier insulin use, and thus improve glycemic control and help reduce the diabetes burden. Pulmonary insulin delivery is the most promising alternative with several inhaled insulin systems in development, and the inhaled human insulin Exubera (insulin human [rDNA origin] Inhalation Powder) has been recently approved in the United States and in the European Union for the treatment of adults with type 1 or type 2 diabetes. Pulmonary function is an important aspect of the safety profile for compounds delivered via the lungs. Pulmonary function with Exubera has been extensively investigated in several completed and ongoing Phase 3 studies conducted in patients with type 1 or type 2 diabetes. A small, consistent but clinically non-significant decrease in pulmonary function, occurs early, does not progress during 2 years of continuous therapy, and is reversible after discontinuation. A mild, transient cou...

Pulmonary safety of inhaled insulins: a review of the current data

https://erj.ersjournals.com/content/erj/3/8/958.full.pdf

Clinical guidelines and indications for bronchoalveolar lavage (BAL): bronchial asthma.

Molecular rather than clinical phenotyping of airway inflammation might be used in the treatment of severe asthmahttp://ow.ly/9Kba308jaXX

https://erj.ersjournals.com/content/erj/49/2/1700053.full.pdf

Severe asthma: phenotyping to endotyping or vice versa?

To determine whether atropine provides protection against the bronchoconstriction that develops in asthmatic subjects after inhalation of ultrasonically nebulized distilled water, we exposed six asthmatic patients to this stimulus with and without pretreatment with atropine (0.04 mg/kg). The mean FEV 1 decreased from 3.32 to 2.39 L (−28%) without and from 3.49 to 3.18 L (−9%) with atropine. This protective effect was statistically significant (p

Effect of atropine on the bronchial response of asthmatic subjects to the inhalation of ultrasonically nebulized distilled water

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