COPD
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Review Biography Historical Article
What we owe to alpha(1)-antitrypsin and to Carl-Bertil Laurell.
The archetypal status of alpha(1)-antitrypsin in biology and medicine grew from the finding, thirty years ago, by Carl-Bertil Laurell, of the association of its deficiency with emphysema. In biology, alpha(1)-antitrypsin now provides the model for both the structure and the remarkable mechanism of the serpin protease inhibitors that control the key proteolytic pathways of the body. In medicine, the plasma deficiency of alpha(1)-antitrypsin has drawn attention to protease-antiprotease imbalance as a contributory cause of chronic obstructive pulmonary disease. ⋯ The extensive development of such diverse fields of studies, each based on alpha(1)-antitrypsin, is a measure of the encouragement Laurell gave to younger colleagues in the field. It also reflects the great advantage of linked contributions from clinical as well as basic sciences. Time after time, scientific controversies and deadlocks have been solved by landmark clinical cases, which have revealed unexpected findings and insights, within and beyond the fields of study.
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COPD mortality alone among major causes of diseases continues to rise in most countries worldwide. We examine trends, and gender and ethnic differences in COPD hospitalization and mortality in Singapore from 1991 to 1998, and examine possible explanations. ⋯ Exceptionally steady declines in COPD mortality rates, and stable rates of hospitalization are observed in Singapore in the 1990s. Differing levels and trends of hospitalization and mortality by gender and ethnicity are related to known demographic variations and trends of smoking prevalence in the country.
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The first National COPD Conference, sponsored by the US COPD Coalition was held in Arlington, Virginia on November 14-15, 2003. The theme for the conference was developed around the Department of Health and Human Services (DHHS) Healthy People 2010 goals for COPD and included plenary speeches, roundtable discussions, abstracts, and workshops on spirometry, patient/physician education materials, and home monitoring/telemetry. ⋯ This summary provides the recommendations from the conference that will be used to develop an action plan for the US COPD Coalition. It includes actions proposed by plenary speakers, roundtable faculty and conference participants.
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Review
The workplace impact of acute exacerbations of chronic bronchitis (AECB); A literature review.
Acute exacerbations of chronic bronchitis (AECB) are known to have a substantial economic burden in terms of medical care costs. The objective of this study was to assess workplace-based costs associated with AECB, including absenteeism and decreased productivity, based on a review of published literature. A secondary goal was to identify factors related to workplace-based costs in AECB. ⋯ A review of the identified literature indicates that patients with chronic bronchitis had more days off work; patients whose exacerbations were treated were less likely to have additional exacerbations and had comparatively less work loss. Findings suggest that clinical outcomes and workplace costs are related. While this relationship is clearer in terms of work loss, further exploration is needed to assess decreased productivity and to evaluate this relationship using objective indicators of absenteeism and productivity rather than recall.
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Review
Factors associated with outcomes of acute exacerbations of chronic obstructive pulmonary disease.
The purpose of this article is to provide a general review of the current literature on the factors associated with the outcomes of hospitalizations, survival and health-related quality of life in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), highlighting the limitations and the complexities in interpretation of the results of current studies. There is no consensus definition for AECOPD; onsets may be difficult to define and the determination of duration elusive. The prevalence of acute exacerbations of COPD (AECOPD) in the community appears to be underestimated as exacerbations are underreported by patients and their doctors. ⋯ Strategies to reduce severe exacerbations of COPD include pharmacological treatment, vaccinations, pulmonary rehabilitation, and home care programs. The optimal strategy for the reduction of hospitalization in COPD remains unclear. Long-term interventional studies are needed to provide clearer information for the prevention of exacerbations and hospitalizations in COPD.