Current opinion in pulmonary medicine
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Chronic obstructive pulmonary disease (COPD) is an important disease worldwide, imposing huge economic burden on society. Outdoor air pollutants have a wide variety of harmful effects on humans, including local effects on the airway and systemic inflammation. Recent publications (2007-2008) on the effects of outdoor air pollutants specifically on COPD patients are reviewed in this article. ⋯ Although there is good evidence linking increased outdoor air pollution to increased morbidity, healthcare resources utilization and higher mortality among patients with COPD, it is controversial whether outdoor air pollution is a key factor in the development of this disease.
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The relevance of antibiotics in the treatment of acute exacerbation has been a matter of debate for several years. Although expert recommendations may vary, there is general agreement about the fact that not all patients will equally experience benefit from antibiotics: apart from decreasing costs, discriminate use of antibiotics is capable of significantly reducing subsequent colonization or infection with antibiotic-resistant bacteria. ⋯ Most of the proposed criteria for prescribing or withholding antibiotics for acute exacerbation have been analyzed in different retrospective study designs. Patients requiring ICU care and mechanical ventilation for chronic obstructive pulmonary disease exacerbation should receive antibiotics. Conversely, antibiotics can be withheld in patients admitted to the emergency department with low serum procalcitonin levels. Patients with type I Anthonisen exacerbation and those with severe functional impairment are likely to benefit from antibiotics. Further investigations are needed to compare long-term outcome in patients treated according to clinical and functional criteria.
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Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide. Although COPD has historically been considered a disease of white male smokers, it now clearly impacts both sexes and all races, with mortality rising fastest in women and African-Americans. Given the scarcity of data about non-African-American minorities, this review will focus on the disparities in COPD susceptibility, diagnosis, and treatment between men and women and between African-Americans and whites. ⋯ The possibility that sex or race or both, may influence COPD susceptibility and progression is of critical importance, and may mean that the potential future impact of the disease has been underestimated. Unfortunately, our understanding of these differences and the efficacy of standard COPD treatments in women and minorities remains limited by the low enrollment in clinical trials.