HIV/AIDS related mortality among adult medical patients in a tertiary health institution in South–South,Nigeria

ObjectiveTo determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition.MethodsThis study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the direct causes of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002.ResultsThe total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21–50 years (82.0%).ConclusionsThe study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa.     

Causes of deaths using verbal autopsy among adolescents and adults in rural western Kenya

Objective To establish causes and patterns of deaths among adolescents and adults (age >11 years) using verbal autopsy (VA) in a rural area of western Kenya where malaria and HIV are common. Methods Village reporters reported all deaths in Asembo and Gem (population 135 000), an area under routine demographic surveillance. After an interval of ≥1 month, a trained interviewer used a structured questionnaire to ask the caretaker about signs and symptoms that preceded death. Three clinical officers independently reviewed the interviews and assigned two unranked causes of death; a common cause was designated as the cause of death. Results In 2003, 1816 deaths were reported from residents; 48% were male and 72% were between 20 and 64 years of age. Most residents (97%) were ill before death, with 60% of illnesses lasting more than 2 months; 87% died at home. Care was sought by 96%; a health facility was the most common source, visited by 73%. For 1759 persons (97%), a common cause of death was designated. Overall, 74% of deaths were attributed to infectious causes. HIV (32%) and tuberculosis (TB) (16%) were the most frequent, followed by malaria, respiratory infections, anaemia and diarrhoeal disease (approximately 6% each). Death in a health facility was associated with young age, higher education, higher SES, a non‐infectious disease cause and a shorter duration of illness. Conclusion In this area, the majority of adult and adolescent deaths were attributed to potentially preventable infectious diseases. Deaths in health facilities were not representative of deaths in the community. Programmes to prevent HIV and TB infection and to decrease mortality have started. Their impact can be evaluated against this baseline information.     

HIV becomes world's leading infectious cause of death

The World Health Organization (WHO) named HIV in 1999 as the leading infectious cause of death in the world, moving ahead of tuberculosis for the first time. WHO estimates that there were 2.3 million AIDS-related deaths in 1998, with the situation being worst in Africa. In 1998, 19 percent of all deaths in Africa were due to AIDS. UNAIDS estimates that there are 39 million people living with HIV infection worldwide, with exploding epidemics in Asia and eastern Europe. The infection rate continues to soar in Africa. A table shows the ten leading causes of death worldwide in 1998.     

The major respiratory diseases of American Indians

The most prominent respiratory diseases of American Indian adults are pneumonia, cancer of the lung, chronic obstructive pulmonary disease (COPD), and tuberculosis. Mortality and hospitalization rates of these diseases were compared with those for the rest of the U.S. population and between Indian groups in the various Indian Health Service Areas. Pneumonia and influenza constitute the sixth leading cause of death among Indians and the fifth leading cause of death among the U.S. All Races population. Chronic obstructive pulmonary disease is the fourth leading cause of death among U.S. All Races, but only the tenth leading cause of death among Indians. Pneumonia and tuberculosis are more significant causes of death and disability for Indians than are COPD and cancer of the lung. The explanation for these differences in mortality rates between Indians and the general population are not known. Respiratory system diseases are responsible for 10.6% of Indian hospitalizations. The most frequent is pneumonia, which accounts for approximately 4% of all Indian hospitalizations. Differences in respiratory diseases between Indian groups are sometimes striking, with a sharp increase in mortality and hospitalization in the Areas across the northern border of the lower 48 states. There is also a much higher prevalence of cigarette smoking in those same Areas.     

广西HIV/AIDS病人死亡影响因素的回顾性调查

目的了解广西壮族自治区（广西）艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（HIV/AIDS病人）中,与AIDS相关死亡病例和非AIDS相关死亡病例的分布情况,以及接受AIDS抗病毒治疗病例死亡的主要影响因素。方法采用AIDS综合防治数据信息系统中的HIV/AIDS死亡病例信息数据进行分析。结果对2010年1月-2011年7月死亡的5 265例有效个案进行分析,临床诊断为AIDS相关疾病死亡2 647例（50.3%）,意外伤害410例（7.8%）,其他疾病或难以确定与AIDS相关疾病的死亡1 973例（37.5%）,不详235例（4.5%）。4 382例（83.2%）未接受抗病毒治疗的主要原因是,发现较晚（46.4%）和家庭经济困难（13.7%）。2004-2011年7月底,累计治疗AIDS病人21 761例,死亡1 718例。在有完整资料的1 694例死亡病例中,825例（48.7%）在治疗后3个月内死亡;1 065例（62.9%）治疗前最近1次检测CD4T淋巴细胞≤50个/μL。结论未能及时就医或诊断时间较晚,免疫功能低下,是HIV/AIDS病人死亡的主要影响因素。要进一步建立健全监测检测和治疗体系,提高覆盖面和可及性,争取HIV/AIDS病人早发现、早诊断,及时开展抗病毒治疗,降低病死率。     

Epidemiology of respiratory infectious diseases

Respiratory infections are a frequent burden to health despite the fact that cost-effective methods for their prevention and cure are available. Acute respiratory infections in children under 5 years of age are the most frequent cause of death from lung disease globally, causing more than 4 million deaths annually. Tuberculosis is the most frequent cause of death from a single pathogen in persons aged 15 to 49 years (a total of 2 million to 3 million deaths annually). Respiratory infections are the most frequent complications of immune deficiency (whether due to HIV infection or induced by chemotherapy). Where a "carrier state" occurs (as with many bacterial pathogens), the level of immune function is the key determinant in appearance of disease. Where there is no carrier state (as with many viruses), exposure is the key determinant. Characteristics of the pathogen, including virulence and bacterial load where there is a carrier state, also determine the probability of respiratory infections. Modifiers of these determinants include allergy and toxic exposures including tobacco smoke and ambient pollution.     

吸烟对慢性阻塞性肺疾病发病机制的影响

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的发病率近年来呈现上升趋势,目前已占到了疾病死亡原因的第4位,预计到2020年将上升到第3位.COPD是一个重要的公众健康问题,它是世界范围内引起高发病率和死亡率的一个重要原因.在我国,40岁以上人群COPD的总患病率达8.2%,呼吸系统疾病(其中COPD占很大部分)在农村处于第3位死因、在城市处于第4位死因,每年有一百万人死亡和五百万人致残.因此,对COPD发病机制的研究显的尤为重要,COPD是一种多因素引起的疾病,既有自身的因素,也有环境因素.在环境因素中,吸烟、空气污染及感染是导致COPD发病的三大危险因素,而其中吸烟是最主要的因素.近年来,吸烟对COPD的影响的研究取得了较大的进展,现综述了近几年吸烟对COPD发病机制的影响,同时希望对COPD发病机制的深入研究有一定的意义.     

Acute respiratory infections are the leading cause of death in children in developing countries

A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.     

Identifying deaths from AIDS in South Africa

OBJECTIVE: To quantify the HIV/AIDS deaths misclassified to AIDS-related conditions in South Africa. DESIGN: Retrospective analysis of vital registration data. METHODS: Cause-specific death rates for 1996 and 2000-2001 were calculated using vital registration cause-of-death profiles applied to a model (ASSA2000) estimate of total mortality rates by age and sex. The difference in the age-specific death rates for these two periods was examined to identify conditions where there was a noticeable increase in mortality following the same age pattern as the HIV deaths, thus likely to be misclassified AIDS deaths. RESULTS: The increase in the age-specific death rates for HIV-related deaths showed a distinct age pattern, which has been observed elsewhere. Out of the 22 potential causes of death investigated, there were nine that increased in the same distinct age pattern (tuberculosis, pneumonia, diarrhoea, meningitis, other respiratory disease, non-infective gastroenteritis, other infectious and parasitic diseases, deficiency anaemias and protein energy malnutrition) and could be considered AIDS-related conditions. The increase in these conditions accounted for 61% of the total deaths related to HIV/AIDS. When added to the deaths classified as HIV-related on the death certificate, the total accounts for 93% of the ASSA2000 model estimates of the number of AIDS deaths in 2000. CONCLUSION: As a large proportion of AIDS deaths appear to be classified to AIDS-related conditions, without reference to HIV, interpretation of death statistics in South Africa cannot be made on face value as a large proportion of deaths caused by HIV infection are misclassified.     

Can we reverse the HIV/AIDS pandemic with an expanded response?

HIV/AIDS has reached pandemic proportions, and is one of the leading causes of death worldwide. In 2001, the Declaration of Commitment on HIV/AIDS set out several aims with respect to reducing the effect and spread of HIV/AIDS, and an expanded response in low-income and middle-income countries was initiated. Here we examine the potential effect of the expanded global response based on analyses of epidemiological data, of mathematical models of HIV-1 transmission, and a review of the impact of prevention interventions on risk behaviours. Analyses suggest that if the successes achieved in some countries in prevention of transmission can be expanded to a global scale by 2005, about 29 million new infections could be prevented by 2010.     

COPD in Asia: where East meets West

COPD is a global health concern, and is a major cause of chronic morbidity and mortality worldwide. According to the World Health Organization, it is currently the sixth leading cause of death in the world, and further increases in the prevalence and mortality of the disease is predicted for the coming decades. These increases are mainly linked to the epidemic of tobacco exposure and indoor and outdoor air pollution in Asian countries. The burden of COPD in Asia is currently greater than that in developed Western countries, both in terms of the total number of deaths and the burden of disease, as measured in years of life lost and years spent living with disability. The types of health-care policies and the practice of medicine vary considerably among the regions of Asia and have an impact on the burden of disease. Treatment aims in Asian countries are based on evidence-based management guidelines. Barriers to the implementation of disease management guidelines are related to issues of resource conflict and lack of organizational support rather than cultural differences in medical practice. To reduce this burden of COPD in Asian countries, there is a need for a multifaceted approach in improving awareness of prevalence and disease burden, in facilitating accurate diagnosis of COPD among chronic respiratory diseases, in championing health policies that reduce the burden of the main risk factors for COPD and in the wider use of evidence-based management for COPD.     

HIV感染者/AIDS病人死亡原因的研究进展

近年来,随着越来越多的艾滋病病毒（HIV）感染者进入艾滋病（AIDS）发病期,越来越多的感染者死于AIDS相关疾病。另外,随着抗病毒治疗的覆盖率不断扩大,HIV感染者/AIDS病人死于AIDS相关疾病的比例不断降低,而死于其他非AIDS相关疾病的比例却不断升高。文章就当前国内外对HIV感染者/AIDS病人死亡原因的有关研究进展进行综述,为医疗机构加强和提高对重点疾病的诊疗技术水平提供理论支持,也为中国AIDS死因监测的建立提供理论依据。     

The Burden of Disease and the Cost of Illness Attributable to Alcohol Drinking—Results of a National Study

Background and Aims: The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Methods: Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability‐Adjusted Life Years (DALY) lost generated by death or disability. Results: In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that €95.1 millions are attributable to alcohol‐related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol‐related diseases were estimated in €95.9 million, totaling €191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Conclusion: Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.     

Impact of human immunodeficiency virus infection on women and infants.

Infection with HIV is a problem of growing magnitude among women and children in the United States. During 1991, AIDS will be among the five leading causes of death for women of childbearing age. Over 80% of children with HIV have acquired the infection vertically, and AIDS is now a leading cause of death of children in many urban areas of the United States. Gender and age have important influences on the progression of HIV disease and on the occurrence of complicating illnesses. Zidovudine can slow HIV disease progression, and several regimens of prophylaxis are effective against P. carinii pneumonia, which is the leading cause of death among adults and children with AIDS. Intravenous immunoglobulin may be effective for prevention of serious infections in some children with symptomatic HIV infection. Ultimately, prevention of HIV infection among women and children depends on targeted education and, possibly, the development of medical strategies for interruption of vertical transmission.     

Differences in the causes of death of HIV-positive patients in a cohort study by data sources and coding algorithms

OBJECTIVES:: To compare causes of death (CoDs) from two independent sources: National Basic Death File (NBDF) and deaths reported to the Spanish HIV Research cohort [Cohort de adultos con infección por VIH de la Red de Investigación en SIDA CoRIS)] and compare the two coding algorithms: International Classification of Diseases, 10th revision (ICD-10) and revised version of Coding Causes of Death in HIV (revised CoDe). METHODS:: Between 2004 and 2008, CoDs were obtained from the cohort records (free text, multiple causes) and also from NBDF (ICD-10). CoDs from CoRIS were coded according to ICD-10 and revised CoDe by a panel. Deaths were compared by 13 disease groups: HIV/AIDS, liver diseases, malignancies, infections, cardiovascular, blood disorders, pulmonary, central nervous system, drug use, external, suicide, other causes and ill defined. RESULTS:: There were 160 deaths. Concordance for the 13 groups was observed in 111 (69%) cases for the two sources and in 115 (72%) cases for the two coding algorithms. According to revised CoDe, the commonest CoDs were HIV/AIDS (53%), non-AIDS malignancies (11%) and liver related (9%), these percentages were similar, 57, 10 and 8%, respectively, for NBDF (coded as ICD-10). When using ICD-10 to code deaths in CoRIS, wherein HIV infection was known in everyone, the proportion of non-AIDS malignancies was 13%, liver-related accounted for 3%, while HIV/AIDS reached 70% due to liver-related, infections and ill-defined causes being coded as HIV/AIDS. CONCLUSION:: There is substantial variation in CoDs in HIV-infected persons according to sources and algorithms. ICD-10 in patients known to be HIV-positive overestimates HIV/AIDS-related deaths at the expense of underestimating liver-related diseases, infections and ill defined causes. CoDe seems as the best option for cohort studies.     

Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that seriously threatens human health and wellbeing, thereby representing an important public health problem. At present, it is the fourth leading cause of death worldwide, and is estimated to become the third greatest cause of death by 2030. In China, the prevalence of COPD is increasing, secondary to an increase in smoking, air pollution and an aging population, resulting in a current the mortality of COPD in China which is higher than the global average. Moreover, the disability-adjusted life year (DALY) rate of COPD in China is still relatively high, with an associated heavy economic burden to patients, their families and society. Unfortunately, current measures for treatment and prevention of COPD in China are not optimal. This primarily results from limited public awareness of COPD and pulmonary function tests amongst residents of China, and the generally poor disease-specific knowledge of primary care doctors. In recent years, a series of preventative strategies have been introduced in China across at the level of national policy, societies and associations, and scientific research. This review focuses upon both the epidemiology of COPD and the current status of preventative and treatment strategies in China.     

Validity of data-derived algorithms for ascertaining causes of adult death in two African sites using verbal autopsy

background Verbal autopsy (VA) is used to ascertain causes of death using information obtained from bereaved relatives. Causes of death can be ascertained from VA questionnaires by a panel of physicians or from predefined algorithms. In a previous study, we developed data-derived algorithms using VA data from 796 adult deaths in hospitals in Tanzania, Ethiopia, and Ghana (primary sites). These computerized algorithms accurately estimated the cause-specific mortality fractions (CSMFs) for deaths due to injuries, meningitis, TB/AIDS and diarrhoeal diseases in the primary sites. Since the same data were used to generate and to validate the algorithms, the accuracy of our algorithms may have been overestimated. We report here on the validity of the algorithms when they were applied to VA data from two secondary sites in Ghana and Tanzania. Here, 'validity' is taken to mean the degree to which the algorithms replicated the physician-generated CSMF for major causes of death, when applied to the same VA data. methods VA interviews were conducted in two secondary sites: in Navrongo, Ghana, on 406 adult deaths, where three local physicians independently reviewed the questionnaires and assigned a cause of death. In Morogoro, Tanzania, VA interviews were conducted on 209 adult deaths, and a panel of physicians independently reviewed the VA questionnaires together with the hospital death certificates or hospital records to determine the cause of death. The CSMF obtained using each algorithm was compared with the CSMF obtained using physician review. results For injuries and meningitis, the algorithms and physician review estimated a similar CSMF in the Morogoro and Navrongo data. For TB/AIDS, the algorithm estimated a similar CSMF as the physicians in Morogoro. The algorithm for diarrhoeal diseases did not agree closely with the physicians in Morogoro or Navrongo. conclusions In general, our data-derived algorithms for assigning causes of death due to injuries, meningitis, and TB/AIDS estimated a similar CSMF as the physicians in the secondary sites. Recommendations for further validation and refinement are discussed. Computerized algorithms offer a potentially quick, affordable, and feasible method for assigning causes of death in mortality surveillance or studies using VA.     

Tuberculosis and tuberculosis/HIV/AIDS-associated mortality in Africa: the urgent need to expand and invest in routine and research autopsies

Frequently quoted statistics that tuberculosis and human immunodeficiency virus (HIV)/AIDS are the most important infectious causes of death in high-burden countries are based on clinical records, death certificates, and verbal autopsy studies. Causes of death ascertained through these methods are known to be grossly inaccurate. Most data from Africa on mortality and causes of death currently used by international agencies have come from verbal autopsy studies, which only provide inaccurate estimates of causes of death. Autopsy rates in most sub-Saharan African countries have declined over the years, and actual causes of deaths in the community and in hospitals in most sub-Saharan African countries remain unknown. The quality of cause-specific mortality statistics remains poor. The effect of various interventions to reduce mortality rates can only be evaluated accurately if cause-specific mortality data are available. Autopsy studies could have particular relevance to direct public health interventions, such as vaccination programs or preventive therapy, and could also allow for study of background levels of subclinical tuberculosis disease, Mycobacterium tuberculosis-HIV coinfection, and other infectious and noncommunicable diseases not yet clinically manifest. Autopsies performed soon after death may represent a unique opportunity to understand the pathogenesis of M. tuberculosis and the pathogenesis of early deaths after initiation of antiretroviral therapy. The few autopsies performed so far for research purposes have yielded invaluable information and insights into tuberculosis, HIV/AIDS, and other opportunistic infections. Accurate cause-specific mortality data are essential for prioritization of governmental and donor investments into health services to reduce morbidity and mortality from deadly infectious diseases such as tuberculosis and HIV/AIDS. There is an urgent need for reviving routine and research autopsies in sub-Saharan African countries.     

Effect of washing hands with soap on diarrhoea risk in the community: a systematic review

We set out to determine the impact of washing hands with soap on the risk of diarrhoeal diseases in the community with a systematic review with random effects meta-analysis. Our data sources were studies linking handwashing with diarrhoeal diseases. Seven intervention studies, six case-control, two cross-sectional, and two cohort studies were located from electronic databases, hand searching, and the authors' collections. The pooled relative risk of diarrhoeal disease associated with not washing hands from the intervention trials was 1.88 (95% CI 1.31-2.68), implying that handwashing could reduce diarrhoea risk by 47%. When all studies, when only those of high quality, and when only those studies specifically mentioning soap were pooled, risk reduction ranged from 42-44%. The risks of severe intestinal infections and of shigellosis were associated with reductions of 48% and 59%, respectively. In the absence of adequate mortality studies, we extrapolate the potential number of diarrhoea deaths that could be averted by handwashing at about a million (1.1 million, lower estimate 0.5 million, upper estimate 1.4 million). Results may be affected by the poor quality of many of the studies and may be inflated by publication bias. On current evidence, washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47% and interventions to promote handwashing might save a million lives. More and better-designed trials are needed to measure the impact of washing hands on diarrhoea and acute respiratory infections in developing countries.     

2. Advances in pharmacotherapy for COPD

Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world. In 1999, COPD ranked sixth among the most common causes of death and twelfth as a worldwide burden of disease. It has been estimated that by the year 2020 COPD will be the third leading cause of death and fifth as a worldwide burden of disease. Thus, COPD is a major medical problem and there is evidence that it is increasing throughout the world. Despite recognition of COPD as an important international health problem, COPD has been neglected among common diseases, with little investment in research on its underlying cellular and molecular mechanisms. Recently, global and Japanese guidelines for COPD have been published. These guidelines seem to be useful to improve the underdiagnosis and undertreatment of COPD. In this review, I describe briefly the current recommendation for pharmacological therapy of stable COPD according to the global and Japanese guidelines for COPD.