Current opinion in pulmonary medicine
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Experts in palliative care have increasingly recognized the global epidemic of chronic obstructive pulmonary disease (COPD), its astonishing rise in prevalence, and its profound impact on patients' quality of life and functional capacity. Unfortunately, patients with COPD receive less advance care planning (ACP) and palliative care as compared with patients with other diseases with similar prognoses. This review highlights recent advances in identifying barriers to ACP and opportunities for providing more effective and timely palliative care. ⋯ Patients with COPD benefit from better integration of palliative and disease-specific care throughout the course of their disease from diagnosis to death. Pulmonary rehabilitation may provide a platform for coordinating integrated care. Health agencies will increasingly expect better coordination of services for patients with this progressive, disabling, and eventually terminal disease.
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Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. ⋯ Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.
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The recognition that asthma and chronic obstructive pulmonary disease (COPD) are not single diseases, but syndromes made up of multiple separate disorders that overlap, has led to attempts to develop a new taxonomy for the disorders of airflow obstruction. A better understanding of the distinct disorders of airways disease has the potential to inform on underlying mechanisms, risk factors, natural history, monitoring and treatment. ⋯ The priority is to further define the distinct phenotypes that make up the syndromes of asthma and COPD. This knowledge could lead to treatments specifically targeted for defined phenotypic groups, rather than for asthma and COPD in general, which represents the current management approach.
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The burden of chronic obstructive pulmonary disease (COPD) is rapidly growing in the Asia-Pacific region. There is the need for region-specific research and analysis of the epidemiology of COPD to raise awareness of the disease and highlight its causes. Such information is essential to for the development of effective national health policies to ensure evidence-based deployment of finite healthcare resources in the prevention and management of COPD. ⋯ COPD is a common disease with a large disease burden throughout the Asia-Pacific region. Effective public health preventive measures coupled with timely case detection are needed for the reversal of trends and the reduction of disease burden.
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the present article will address the potential for bronchial thermoplasty to be used in addition to conventional medications to help us treat our patients with severe asthma. ⋯ bronchial thermoplasty represents a novel approach to asthma treatment that is complementary to anti-inflammatory and bronchodilating therapies. Criteria for selecting appropriate patients are established and experience with bronchial thermoplasty is expanding since US Food and Drug Administration approval was obtained in April 2010.