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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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.
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The purpose of this review is to highlight seminal and current literature that informs our understanding of the clinical and investigative utility of biomarkers in asthma. Biomarkers derive from a variety of sources [bronchiolar lavage (BAL), sputum, exhaled breath, and blood], and have widely variant performance characteristics, and applicability. ⋯ To date, the best validated, and best performing biomarkers for clinical asthma appear to be measures of inflammation in induced sputum, and measures of ENO. Some trials using ENO appear particularly promising for early clinical use. EBC metrics are at present too inchoate for clinical purposes. However, not all important clinical and research questions can be addressed with sputum, EBC, or ENO metrics, leaving an important place for BAL, bronchial biopsy, and perhaps EBC measurements in the research arena.
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This review examines the changes in the revised National Asthma Education and Prevention Program (NAEPP) Guidelines for the diagnosis and management of asthma pertaining to children and highlights areas that may benefit from further study. ⋯ The recent NAEPP Asthma Guidelines improve on many areas of the diagnosis and treatment of asthma in children and lead to the identification of areas that would benefit from further research.
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There is growing awareness in both adult and paediatric respiratory clinics regarding the importance of non-cystic fibrosis bronchiectasis. There has been debate regarding the requirement for investigations to establish an underlying cause of bronchiectasis. Furthermore, there has been growing interest in establishing the role of bacteria in disease progression. ⋯ Non-cystic fibrosis bronchiectasis can be approached in a systematic fashion to establish the underlying cause and develop treatment strategies.