The clinical respiratory journal
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The reduction in the ratio between forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) is used for the diagnosis of chronic obstructive pulmonary disease (COPD). The choice between a simple fixed cut-off ratio (FEV1/FVC <0.70) and the use of lower limit of normal (LLN) is eagerly discussed. The aim of this paper was to examine the impact of these two diagnostic measures on the prevalence of COPD using data from the fourth examination of The Copenhagen City Heart Study (CCHS4). ⋯ Using the fixed ratio for diagnosing COPD in an epidemiological setting results in a higher prevalence than if the LLN is used. Time seems ripe for studying if the same is seen when diagnosing COPD in the clinical setting.
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Genetic factors contribute as major determinants in the pathophysiological mechanisms of chronic obstructive pulmonary disease (COPD). Therefore, identification of candidate genes and various gene polymorphisms have improved our understanding of COPD. ⋯ This is the first report that examined HIF1A polymorphisms in COPD and demonstrated a possible role of HIF-1α in COPD, as well as GSTP1 and EPHX1.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy and safety of the long-acting muscarinic antagonist GSK233705 delivered once daily in patients with COPD.
GSK233705 is a recently developed inhaled anticholinergic being investigated for the potential treatment of chronic obstructive pulmonary disease (COPD). ⋯ All doses of GSK233705 demonstrated bronchodilatory activity and were well tolerated. Although the onset of bronchodilation was rapid, it was not sustained over 24 h making it unsuitable for once-daily dosing.
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Current guidelines recommend tailoring of asthma management according to disease control, which is largely defined by increased symptoms and deterioration in lung function. These features do not reflect the severity nor the type of the asthmatic airway inflammation. Fractional exhaled nitric oxide (FE(NO)) is a simple, non-invasive and cost-effective online test applicable in both adults and children. In addition to symptoms and lung function measurements, FE(NO) reflects airway eosinophilia and hence allows online assessment of the corticosteroid-sensitive T helper 2 type airway inflammation in asthmatic patients. FE(NO) can thus be applied to aid asthma diagnosis and treatment monitoring both in clinical practice and for research purposes. ⋯ In several studies, FE(NO) measurements provided additional information on aspects of asthma including phenotyping, corticosteroid-responsiveness and disease control. Thus, if correctly applied and interpreted, FE(NO) can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published a strategy for diagnosis and for management of chronic obstructive pulmonary disease (COPD) since 2001 and this has formed the basis for numerous national and regional guidelines. ⋯ A more clinically oriented GOLD document will hopefully improve assessment and management of COPD.