A panel of multiple markers associated with chronic systemic inflammation and the risk of atherogenesis is detectable in asthma and chronic obstructive pulmonary disease

Asthma and chronic obstructive pulmonary disease (COPD) are both lung diseases involving chronic inflammation of the airway. The injury is reversible in asthma whereas it is mostly irreversible in COPD. Both patients of asthma and COPD are known at risk for cardiovascular disease (CVD) and type 2 diabetes (T2DM), nephropathy, and cancer. We measured multiple risk markers for atherogenesis in 55 patients with asthma and 62 patients with COPD. We wanted to know whether risk markers for atherogenesis corresponding to sequence of events of chronic inflammation were also detectable in the airway inflammatory diseases. Elevation of almost all markers involving inflammation of the endothelial cells in the coronary artery were detectable in asthma and COPD involving the inflammation of the epithelial cell lining of the airway. Both the level and % elevation of all markers were found mostly higher in COPD, the more severe form of the lung disease. We believe that these markers are useful for predicting risk of developing clinical complications such as CVD.     

Distinguishing chronic obstructive pulmonary disease from asthma

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases in the UK. Good management of both diseases results in better symptom control and improved quality of life for the patient, but will rely on all members of the primary healthcare team sharing the aims of management as well as helping to implement those goals. The two diseases share many clinical features and similar drugs can be used to treat them both. However there are important clinical differences which help to distinguish them from each other. The management of the two diseases differs in drug regimens and in the long-term aims of management. This article clarifies the important features that distinguish asthma from COPD and which allow patients to receive the best specific management.     

Moving towards a new generation of animal models for asthma and COPD with improved clinical relevance

Asthma and chronic obstructive pulmonary disease (COPD) are complex inflammatory airway diseases characterised by airflow obstruction that remain leading causes of hospitalization and death worldwide. Animal modelling systems that accurately reflect disease pathophysiology continue to be essential to the development of new therapies for both conditions. In this review, we describe preclinical in vivo models that recapitulate many of the features of asthma and COPD. Specifically, we discuss the pro's and con's of the standard models and highlight recently developed systems designed to more accurately reflect the complexity of both diseases. For instance, clinically relevant allergens (i.e. house dust mite) are now being used to mimic the inflammatory changes and airway remodelling that result after chronic allergen exposures. Additionally, systems are being developed to mimic steroid-resistant and viral exacerbations of allergic inflammation - aspects of asthma where there is an acute need for new therapies. Similarly, COPD models have evolved to align with the improved clinical understanding of the factors contributing to disease progression. This includes using cigarette smoke to model not only airway inflammation and remodelling, but some systemic changes (e.g. hypertension and skeletal muscle alterations) that are thought to influence disease. Further, mouse genetics are being exploited to gain insights into the genetics of COPD susceptibility. The new models of asthma and COPD described herein demonstrate that improved clinical understanding of the diseases and better preclinical models is an iterative process that will hopefully lead to therapies that can effectively manage severe asthma and COPD.     

The change in the activity of angiotensin converting enzyme in patients with pneumonia and chronic obstructive pulmonary diseases

The activity of angiotensin-converting enzyme (ACE) was measured in the serum and bronchial contents of 69 patients with pneumonia and 77 with chronic obstructive pulmonary diseases (COPD). ACE activity was decreased both in the blood and bronchial contents during the acute phase of pneumonia. With resolution of the inflammatory process, ACE activity normalized. In patients with COPD, the activity of ACE is decreased during remission in comparison with the mean values in the population. During COPD exacerbation the activity of ACE increases both in the blood and bronchial contents. Changes in ACE activity in pneumonia and COPD are more pronounced in the bronchial contents than in the blood. Presumably alteration of the enzyme concentration is the only cause of alteration of its activity in patients with COPD and pneumonia.     

COPD heterogeneity: what this will mean in practice

COPD is a complex collection of conditions. All share the feature of limited expiratory air flow. It is a "disease" in the same sense as is "chronic renal failure." Like most other chronic organ failure "diseases," COPD has disparate causes, and patients are heterogeneous in their prognosis and response to treatment. Unlike many other diseases, the heterogeneity of COPD is just beginning to be described. A number of large trials funded by the National Institutes of Health and industry promise to refine the classification of COPD. Based on accurate diagnosis of COPD subtypes, novel treatments can be more effectively developed and implemented. The clinical implications of improved understanding of COPD heterogeneity will be better care and outcomes for COPD patients, which will depend on increased diagnostic accuracy and selective administration of treatments.     

Effects of air pollution and smoking on chronic obstructive pulmonary disease and bronchial asthma.

Although both tobacco smoking and air pollution are believed to be environmental factors affecting the prevalence of chronic obstructive pulmonary disease (COPD) and bronchial asthma, the mechanisms by which they induce/aggravate these diseases are still not known in detail. While smoking has been demonstrated to cause and aggravate COPD and bronchial asthma, the influence of air pollution, suspected to have hazardous environmental effects since the historical episodes of severe air pollution such as the London Smog, on the prevalence of airway diseases remains unclear. This is due, in part, to changes over time in the nature of the air pollutants concerned. There have been no consistent findings on the effects on airway diseases of air pollutants at levels currently observed in developed countries. It is believed that cessation of smoking is the most important factor in preventing the development of COPD.     

Diseases to differentiate from COPD, with emphasis on bronchial asthma

Differential diagnosis of chronic obstructive pulmonary disease (COPD) from asthma is not a difficult task for many clinicians. Patients with COPD have a history of heavy smoking and show a slowly progressive dyspnea on exertion and there is little variability in symptoms, and they show a poor response to bronchodilators and corticosteroids. Asthma usually begins in early childhood with atopy, shows episodic dyspnea with wheezing, especially during night and early morning. Some patients, however, show adult onset, irreversible airflow limitation, and neutrophilic airway inflammation. The airway remodeling in asthma may be the cause of confusing pathophysiology. Other diseases showing airway hyperresponsiveness, such as allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome, and left heart failure presenting cardiac asthma, may sometimes show similar clinical pictures to COPD. Chronic airway diseases are also possible candidates for differential diagnosis of COPD. Bronchiectasis, sinobronchial syndrome, diffuse panbronchiolitis, obliterative bronchiolitis, and other chronic airway diseases should be considered. Some interstitial lung diseases, such as smoking-related interstitial lung diseases and lymphangioleiomyomatosis, often show obstructive ventilatory impairment, and therefore should be considered in differential diagnosis of COPD.     

Spiral computed tomography with functional tests in diagnosis of chronic obstructive diseases of the lungs

The potential of spiral computed tomography (SCT) and high resolution computed tomography (HRST) in diagnosis of chronic obstructive pulmonary diseases (COPD) is described. Semiotic sings of bronchial asthma (BA) and chronic obstructive bronchitis (COB) are specified. Informative value of SCT in differential diagnosis of BA and COB including early stage of the diseases is analysed. An updated technique of SCT and HRCT of the lungs in COPD patients is presented.     

The role of the NLRP3 inflammasome in the pathogenesis of airway disease

The incidences of respiratory diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD) are increasing dramatically. Significantly, there are currently no treatments that can slow or prevent the relentless progression of COPD; and a sub-population of asthmatics are resistant to available therapies. What is more, currently prescribed medication has only minimal effect on the symptoms suffered in these patient groups. There is therefore an urgent need to develop effective drugs to treat these diseases. Whilst asthma and COPD are thought to be distinct diseases, it is currently believed that the pathogenesis of both is driven by the chronic inflammation present in the airways of these patients. It is thus hypothesised that if the inflammation could be attenuated, disease development would be slowed and symptoms reduced. It is therefore paramount to determine the pathways driving/propagating the inflammation. Recently there has been a growing body of evidence to suggest that the multimeric protein complex known as the Inflammasome may play key roles in the inflammation observed in respiratory diseases. The aim of this review is to discuss the role of the NLRP3 Inflammasome, and its associated inflammatory mediators (IL-1β and IL-18), in the pathogenesis of asthma and COPD.     

Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease

Exacerbations of chronic obstructive respiratory disease (ECOPD) are acute events characterized by worsening of the patient's respiratory symptoms, particularly dyspnoea, leading to change in medical treatment and/or hospitalisation. AECOP are considered respiratory diseases, with reference to the respiratory nature of symptoms and to the involvement of airways and lung. Indeed respiratory infections and/or air pollution are the main causes of ECOPD. They cause an acute inflammation of the airways and the lung on top of the chronic inflammation that is associated with COPD. This acute inflammation is responsible of the development of acute respiratory symptoms (in these cases the term ECOPD is appropriate). However, the acute inflammation caused by infections/pollutants is almost associated with systemic inflammation, that may cause acute respiratory symptoms through decompensation of concomitant chronic diseases (eg acute heart failure, thromboembolism, etc) almost invariably associated with COPD. Most concomitant chronic diseases share with COPD not only the underlying chronic inflammation of the target organs (i.e. lungs, myocardium, vessels, adipose tissue), but also clinical manifestations like fatigue and dyspnoea. For this reason, in patients with multi‐morbidity (eg COPD with chronic heart failure and hypertension, etc), the exacerbation of respiratory symptoms may be particularly difficult to investigate, as it may be caused by exacerbation of COPD and/or ≥ comorbidity, (e.g. decompensated heart failure, arrhythmias, thromboembolisms) without necessarily involving the airways and lung. In these cases the term ECOPD is inappropriate and misleading.     

慢性阻塞性肺疾病合并肺纤维化临床分析

目的 了解慢性阻塞性肺疾病合并肺纤维化的临床特点，探讨其临床意义。方法 对比分析我院1990～2002年诊断的慢性阻塞性肺疾病(COPI))合并肺纤维化14例及特发性肺纤维化(IPF)20例患者的症状、体征、X线胸片、胸部高分辨CT(HRCT)、肺功能、血气分析结果。结果 COPD合并肺纤维化及IPF在发病年龄、性剐方面无差别，而前者从发病至就诊时间明显较后者长。COPD合并肺纤维化常在慢性咳嗽基础上出现进展较快的呼吸困难及Velcro啰音，具有两种病变并存的X线及CT表现，常为混合型通气功能障碍，低氧血症明显，二氧化碳潴留则有所减轻。结论 慢性阻塞性肺疾病与肺间质纤维化具有不同的临床特点，当二者并存时，各自的特点则不明显，兼有二者的特征。     

Prevalence of chronic obstructive pulmonary diseases in general clinics in terms of FEV1/FVC

Background: The prevalence of chronic obstructive pulmonary disease (COPD) continues to increase all over the world. Nonetheless, COPD is often misdiagnosed in general clinics because of insufficient use of spirometry. Objectives: To estimate the prevalence of COPD in general clinics in Japan, we performed spirometry to screen patients who consulted general clinics. Methods: Patients 40 years of age and older who consulted clinics in Nagasaki Prefecture, Japan, for non‐respiratory diseases and who met certain inclusion criteria had their airflow limitation measured by spirometry. We defined COPD as forced expiratory volume in the first second (FEV₁) over forced vital capacity (FVC) (FEV₁/FVC) of < 70% in patients without active pulmonary disease, including physician‐diagnosed asthma. Results: Of the 1424 patients included in the study, 193 (13.6%) showed airflow limitation. Airflow limitation was significantly related to older age, male gender and cumulative pack‐years. FEV₁/FVC in patients with hypertension and chronic hepatitis were significantly lower than in patients without these diseases when adjusted for age, gender and pack‐years. Conclusions: We showed that there are potentially a number of cases with COPD that are undiagnosed by general physicians in Japan. Measuring airflow limitation by spirometry in smokers with coexisting diseases, such as hypertension and chronic hepatitis, may be very beneficial because COPD is thought to be a systemic disease. The distribution of spirometers to general clinics is definitely needed to detect undiagnosed COPD.     

Asthma and COPD: differences and similarities. With special reference to the usefulness of budesonide/formoterol in a single inhaler (Symbicort) in both diseases

Asthma and chronic obstructive pulmonary disease (COPD) both have a high prevalence worldwide and yet each condition remains underdiagnosed. Despite a number of common features, these inflammatory respiratory syndromes have distinct clinical outcomes. COPD represents a greater economic burden than asthma because it has a less favourable prognosis and is associated with greater morbidity and mortality. Therefore, it is important to distinguish between these two diseases at an early stage, so that appropriate therapy can be prescribed to prevent deterioration. However, effective treatments that may be used in both conditions can minimise the effects of misdiagnosis and maximise the impact of treatment without the associated complexity when both conditions occur together. The current review summarises the differences and similarities of asthma and COPD, in terms of risk factors, pathophysiology, symptoms and diagnosis, to provide greater understanding of the role of budesonide/formoterol in a single inhaler in both diseases.     

Early discharge of people with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe any respiratory condition that causes long-standing airflow obstruction, which is non or only partially reversible with bronchodilator therapy. These diseases include emphysema, chronic bronchitis, chronic airflow limitation and some cases of chronic asthma. The World Health Organization global initiative for chronic obstructive lung disease (GOLD) recommendations proposed a new definition of COPD as 'a disease state characterised by a progressive airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases' (Pauwels et al, 2001).     

老年慢性阻塞性肺疾病患者生存质量及其影响因素分析

目的　探讨老年慢性阻塞性肺疾病 (COPD)患者生存质量及其影响因素的关系。方法　用生活质量问卷表对 5 0 0例 6 0岁以上老年COPD患者进行调查 ,并用多元逐步回归方法对老年COPD患者生存质量的影响因素进行分析。结果　身体健康状态和日常生活能力是影响老年COPD患者生存质量的主、客观评价共有的第 1、2位因素 ,COPD是老年人身体患病率仅次于心血管疾病而位居第二位的老年慢性疾病。结论　加强老年COPD患者的健康教育和医疗保健 ,积极预防和治疗高血压、冠心病、骨关节疾病等老年常见病对提高老年COPD患者生存质量有显著作用。     

慢性阻塞性肺疾病合并肺间质纤维化的临床分析

目的 探讨慢性阻塞性肺疾病(COPD)合并肺间质纤维化(PF)的临床特点以及两者之间的关系.方法 对比分析我院2001年7月至2010年10月确诊的PF-COPD患者27例(PF-COPD)组及COPD患者30例(COPD组)的症状、体征、肺功能、动脉血气分析及胸部X线片和CT及高分辨CT(HRCT)结果.结果 PF-COPD组患者临床表现介于此两种疾病之间.肺功能检查示:PF-COPD组以混合性通气功能障碍为主(18与0;x2=17.10,P＜0.01),而COPD组30例均为阻塞性通气功能障碍(30与9;x2 =15.72,P＜0.01).血气分析示:PF-COPD组低氧血症较为明显,COPD组PaCO2升高较多见,但两组比较差异无统计学意义(P＞0.05).胸部X线显示,COPD组30例胸廓前后径均增大,PF-COPD组则为14例(P＜0.05),而PF-COPD组点状、网状或蜂窝状改变24例,COPD组则无此改变(P＜0.01);胸部CT及HRCT示:PF-COPD组肺部磨玻璃状改变、网格结节影均较COPD组高(9与0、19与0;x2=10.85、17.36,P均＜0.01).结论 PF-COPD具有独特的临床特点,兼有二者的特征.胸部HRCT能为临床提供重要诊断依据.     

慢性阻塞性肺疾病急性加重疏于解表论

慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)已成为我国慢性疾病中重要组成部分,患病率和人数不断上升,中医药对于慢阻肺急性加重(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的治疗发挥重要作用,现代医学对于慢阻肺急性加重主要从"虚、痰、瘀"论治,然AECOPD的重要诱因是外感,故解表不可或缺,该文从病机上探讨解表之功,为临床治疗慢阻肺急性加重提供一定的理论依据。     

The stomach and duodenum condition in patients with chronic obstructive lung diseases

Examining the gastroduodenal mucosa (GDM) in 61 patients with chronic obstructive pulmonary diseases (COPD) showed changes in the areas studied in all cases. GDM atrophy increased with the severity of COPD. Helicobacter pylori are essential in developing gastric pathology in patients with mild bronchopulmonary disease. The severity of atrophic gastritis increases with the longer duration of COPD and with more severity of hypoxia and bronchial obstruction.     

Anaemia in chronic obstructive pulmonary disease. Does it really matter?

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases, with an increasing rate in morbidity and mortality. In recent years, there has been a greater awareness about the clinical importance of systemic effects and other chronic conditions associated with COPD, as these significantly impact on the course of disease. The most studied extrapulmonary manifestations in COPD include the presence of concomitant cardiovascular disease, skeletal muscle wasting, osteoporosis and lung cancer. Anaemia is a recognised independent marker of mortality in several chronic diseases. Recent studies have shown that anaemia in patients with COPD may be more frequent than expected, with a prevalence ranging from 5% to 33%. Some evidence suggests that systemic inflammation may play an important pathogenic role, but anaemia in COPD is probably multifactorial and may be caused by others factors, such as concealed chronic renal failure, decreased androgenic levels, iron depletion, angiotensin‐converting enzyme inhibitor treatment and exacerbations. Low levels of haemoglobin and haematocrit in COPD patients have been associated with poor clinical and functional outcomes as well as with mortality and increased healthcare costs. Despite the potential clinical benefit of successfully treating anaemia in these patients, evidence supporting the importance of its correction on the prognosis of COPD is uncertain.     

Sexualit?t bei Patienten mit beeintr?chtigter Atmung

Zusammenfassung Hintergrund: Das Thema "Sexualität bei chronischen Erkrankungen" findet zunehmend Beachtung. Bei der Mehrzahl der Patienten mit Lungenerkrankungen ist die Sexualität beeinträchtigt. In diesem Zusammenhang liegen die meisten Untersuchungsergebnisse zu Patienten mit chronisch-obstruktiver Lungenerkrankung (COPD) vor. Pathogenese: Vor allem Luftnot, Husten, motorische Schwäche und die assoziierte Einschränkung der körperlichen Mobilität sind wesentliche somatische Ursachen für die Abnahme der sexuellen Aktivität bei Patienten mit COPD. Neben dem unmittelbar bestehenden somatisch-physischen Schaden führen psychosoziale Beeinträchtigung und die Nebenwirkungen der Pharmakotherapie zur sexuellen Dysfunktion. Therapie: Bei den therapeutischen Optionen ist die gelungene Kommunikation zwischen Patient und Arzt wichtig. Unter Anwendung bestimmter Therapiemaßnahmen und Verhaltensweisen ist es auch dem Patienten mit einer schwergradigen Lungenerkrankung möglich, sexuell aktiv zu sein. Hierzu gehören die Pharmakotherapie und im Bedarfsfall die lokale Behandlung der sexuellen Dysfunktion. Bei bestehender Indikation zur Sauerstofflangzeittherapie sollte diese auch während des Geschlechtsverkehrs fortgesetzt werden. Bei chronischer ventilatorischer Insuffizienz kann die nichtinvasive Beatmung zur Zunahme der sexuellen Aktivität führen. Abstract Background: Sexuality in chronic diseases is of increasing significance. In the majority of patients with chronic lung diseases, sexual activity is reduced. Most available data on this topic are based on patients with chronic obstructive pulmonary diseases (COPD). Pathogenesis: Dyspnea, cough, muscular weakness, and the associated reduction of physical activity are the main causes of reduced sexual activity in COPD patients. In addition to direct somatic-physical effects of COPD, the associated psychosocial deficits and adverse effects of medication contribute to sexual dysfunction. Treatment: An intact communication between physician and patients is an important issue within a therapeutic strategy. Applying both treatment and behavioral strategies enables even patients with severe lung diseases to be sexually active. Somatic therapy consists of both systemic medication and local interventions to treat sexual dysfunction. If oxygen therapy is indicated, it should be administered also during intercourse. In patients with chronic ventilatory failure, sexual activity may profit from noninvasive mechanical ventilation.