2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

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.

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Global strategy for asthma management and prevention

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Objective The goal of asthma management is to achieve optimal asthma control, defined by the absence of daytime symptoms, nighttime waking, reliever use, functional limitation, and lung function stability, and to also reduce the future risks of asthma exacerbations, deterioration in lung function, and the medication’s adverse effects. The most widely used maintenance therapy is inhaled corticosteroids (ICSs). This review considered the evidence in which the combination of the ICS budesonide and the rapid-onset long-acting β-agonist (LABA) formoterol can be used as a standard of care for maintenance and reliever therapy in moderate to severe asthma. Data Sources The archival literature of peer-reviewed studies on the efficacy and safety of budesonide-formoterol as maintenance and reliever therapy in moderate to severe asthma. Results The ICS-LABA combination containing budesonide-formoterol reduces future risk of severe asthma exacerbations and provides similar levels of day-to-day asthma control when compared with using high-dose ICS alone, or combination ICS-LABA therapy and short-acting β2-agonist as a reliever. Conclusion Budesonide-formoterol as a single combination maintenance and reliever inhaler is effective in reducing asthma exacerbation risk, requires a lower maintenance dose of ICS, and results in a simplified approach to asthma management.

Asthma maintenance and reliever therapy: Should this be the standard of care?

Roflumilast for asthma: Efficacy findings in non-placebo-controlled comparator and dosing studies.

Background: IL-10 is an anti-inflammatory cytokine released from various cells, including T cells. The role of IL-10 in asthma pathogenesis remains uncertain. Allergen inhalation by atopic asthmatic subjects results in 2 bronchoconstrictor phenotypes: isolated early response and dual response. Persistence of allergen-induced airway inflammation is a feature of dual responders. Objectives: The kinetics of IL-10 production in circulating T cells were investigated to examine a potential role of IL-10 in allergen-induced responses and airway inflammation. Methods: Fourteen subjects with mild asthma (7 isolated early and 7 dual responders) were challenged with allergen. PBMCs taken before and 24 hours after allergen challenge were processed for intracellular IL-10 staining with fluorescent-conjugated anti-IL-10 antibody. The frequency of IL-10-producing cells was assessed for CD4 + and CD8 + T-cell subsets by using flow cytometry. Results: Before allergen administration, the frequency of IL-10-producing CD4 + cells was significantly higher in dual than in isolated early responders. IL-10-producing CD4 + cells significantly increased after allergen in early responders, whereas IL-10-producing CD4 + cells significantly decreased in dual responders. Simultaneous assessments of IL-5-producing T cells did not show any differences between each group before or after allergen administration. Conclusions: These results suggest that the contrasting profiles of IL-10 production may be associated with the different time course of allergen-induced airway inflammation between allergen-induced early and dual responders. (J Allergy Clin Immunol 2002;109:281-6.)

IL-10 production in circulating T cells differs between allergen-induced isolated early and dual asthmatic responders

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Asthma maintenance and reliever therapy: Should this be the standard of care?

Roflumilast for asthma: Efficacy findings in non-placebo-controlled comparator and dosing studies.

IL-10 production in circulating T cells differs between allergen-induced isolated early and dual asthmatic responders