Integrative Omics to Characterize and Classify Pulmonary Vascular Disease
Advances in high-throughput biotechnologies have facilitated omics profiling, a key component of precision phenotyping, in patients with pulmonary vascular disease. Omics provides comprehensive information pertaining to genes, transcripts, proteins, and metabolites. The resulting omics big datasets may be integrated for more robust results and are amenable to analysis using machine learning or newer analytical methodologies, such as network analysis. Results from fully integrated multi-omics datasets combined with clinical data are poised to provide novel insight into pulmonary vascular disease as well as diagnose the pres...
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Jane A. Leopold, Anna R. Hemnes Source Type: research

Sex Differences in Pulmonary Hypertension
This article discusses clinical and preclinical studies that have investigated the influences of sex, serotonin, obesity, estrogen, estrogen synthesis, and estrogen metabolism on bone morphogenetic protein receptor type II signaling, the pulmonary circulation and right ventricle in both heritable and idiopathic pulmonary hypertension. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Hannah Morris, Nina Denver, Rosemary Gaw, Hicham Labazi, Kirsty Mair, Margaret R. MacLean Source Type: research

Advanced Imaging in Pulmonary Vascular Disease
This article discusses the current role of advanced imaging and the emerging novel techniques for visualizing the lung parenchyma, mediastinum, and heart in PVD. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Eileen M. Harder, Rebecca Vanderpool, Farbod N. Rahaghi Source Type: research

Congenital Heart Disease-Associated Pulmonary Hypertension
Presently, with increasing survival of patients with congenital heart disease (CHD), pulmonary arterial hypertension (PAH) associated with CHD is commonly encountered in children and adults. This increased prevalence is seen despite significant advances in early diagnosis and surgical correction of patients with structural CHD. PAH is the cause of significant morbidity and mortality in these patients and comes in many forms. With the increased availability of targeted therapies for PAH, there is hope for improved hemodynamics, exercise capacity, quality of life, and possibly survival for these patients. There may also be o...
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Erika B. Rosenzweig, Usha Krishnan Source Type: research

Adaptation and Maladaptation of the Right Ventricle in Pulmonary Vascular Diseases
The right ventricle is coupled to the low-pressure pulmonary circulation. In pulmonary vascular diseases, right ventricular (RV) adaptation is key to maintain ventriculoarterial coupling. RV hypertrophy is the first adaptation to diminish RV wall tension, increase contractility, and protect cardiac output. Unfortunately, RV hypertrophy cannot be sustained and progresses toward a maladaptive phenotype, characterized by dilation and ventriculoarterial uncoupling. The mechanisms behind the transition from RV adaptation to RV maladaptation and right heart failure are unraveled. Therefore, in this article, we explain the main t...
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Aida Lluci à-Valldeperas, Frances S. de Man, Harm J. Bogaard Source Type: research

Chronic Thromboembolic Disease and Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary vascular disease (CTED) are rare manifestations of venous thromboembolism. Presumably, CTEPH and CTED are variants of the same pathophysiological mechanism. CTEPH and CTED can be near-cured by pulmonary endarterectomy, balloon pulmonary angioplasty, and medical treatment with Riociguat or subcutaneous treprostinil, which are the approved drugs. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 12, 2021 Category: Respiratory Medicine Authors: Irene M. Lang, Ioana A. Campean, Roela Sadushi-Kolici, Roza Badr-Eslam, Christian Gerges, Nika Skoro-Sajer Source Type: research

Pulmonary Hypertension in Pregnancy
This article (a) highlights the normal anatomic and physiologic changes that accompany pregnancy and the potential deleterious consequences on the cardiopulmonary circulation in pregnant PH patients and (b) provides an in-depth approach in the management of the pregnant PH patient. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 8, 2021 Category: Respiratory Medicine Authors: Inderjit Singh, Evelyn Horn, Jennifer Haythe Source Type: research

Pulmonary Vascular Disease as a Systemic and Multisystem Disease
This article covers the chronic heart failure syndrome, including the systemic consequences of right ventricle-pulmonary artery uncoupling and neurohormonal activation, skeletal and respiratory muscle effects, systemic endothelial dysfunction and coronary artery disease, systemic inflammation and infection, endocrine and metabolic changes, the liver and gut axis, sleep, neurologic complications, and skin and iron metabolic changes. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 8, 2021 Category: Respiratory Medicine Authors: Katherine Kearney, Eugene Kotlyar, Edmund M.T. Lau Source Type: research

The Evolution in Nomenclature, Diagnosis, and Classification of Pulmonary Hypertension
The current description of pulmonary hypertension is a testament to the physicians and scientists who dedicated their lives to furthering understanding of the pulmonary circulation. This has spanned a millennium, from ancient Egyptian descriptions of human anatomy to the current molecular and hemodynamic phenotyping of pulmonary hypertension. The recent Sixth World Symposium on Pulmonary Hypertension is a direct result of these discoveries and reflects an evolution in a classification scheme that has spanned half a century. This provides a framework for future directions related to therapeutics and mechanisms of disease. (...
Source: Clinics in Chest Medicine - January 8, 2021 Category: Respiratory Medicine Authors: Jan Fouad, Phillip Joseph Source Type: research

Contemporary Pharmacotherapeutic Approach in Pulmonary Arterial Hypertension
This article journeys through the development of therapeutic approaches for pulmonary arterial hypertension. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - January 7, 2021 Category: Respiratory Medicine Authors: Jalil Ahari, Akshay Bhatnagar, Anna Johnson, Mardi Gomberg-Maitland Source Type: research

Preoperative Assessment and Perioperative Management of the Patient with Pulmonary Vascular Disease
The incidence of pulmonary hypertension (PH) in patients undergoing noncardiac surgery has increased steadily over the past decade. Patients with known PH have significantly higher perioperative morbidity and mortality than those without PH. Moreover, a substantial number of patients may have occult disease. It, therefore, is of paramount importance for perioperative providers to recognize high-risk patients and treat them appropriately. This review first provides an overview of PH pathophysiology, then estimates the perioperative incidence of PH and its impact on surgical outcomes, and finally outlines a perioperative man...
Source: Clinics in Chest Medicine - January 7, 2021 Category: Respiratory Medicine Authors: Jochen Steppan, Paul M. Heerdt Source Type: research

Work-Related Upper-Airway Disorders
Work-related rhinitis and laryngeal disorders are common and can significantly contribute to work absences and presenteeism. Each can cause respiratory symptoms that may be misdiagnosed as asthma symptoms, and each may occur as an isolated disorder or may also accompany asthma. Suspicion of these disorders and correct management require a careful medical and occupational history. Investigations for work-related rhinitis include examination of the nose, allergy skin tests, and in some cases, monitoring of peak inspiratory nasal flows at work and off work, or specific challenge tests. Work-related laryngeal disorders require...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Ambrose Lau, Susan M. Tarlo Source Type: research

Coal Workers ’ Pneumoconiosis and Other Mining-Related Lung Disease
Coal workers ’ pneumoconiosis (CWP) and other mining-related lung diseases are entirely preventable, yet continue to occur. While greater attention has been given to CWP and silicosis, mining exposures cause a broad spectrum of respiratory disease, including chronic bronchitis, emphysema, and pulmonary fibrosi s. Physicians must obtain a detailed occupational and exposure history from miners in order to make an accurate diagnosis and determine the risk of disease progression. Mining-related lung diseases are incurable and difficult to treat. Therefore, primary prevention by limiting dust exposure and seco ndary preve...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Leonard H.T. Go, Robert A. Cohen Source Type: research

Occupational Respiratory Infections
Occupational respiratory infections can be caused by bacterial, viral, and fungal pathogens. Transmission in occupational settings can occur from other humans, animals, or the environment, and occur in various occupations and industries. In this article, we describe 4 occupationally acquired respiratory infections at the focus of NIOSH investigations over the last decade: tuberculosis (TB), influenza, psittacosis, and coccidioidomycosis. We highlight the epidemiology, clinical manifestations, occupational risk factors, and prevention measures. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Marie A. de Perio, Miwako Kobayashi, Jonathan M. Wortham Source Type: research

Update on Climate Change
Climate change is a crisis of vast proportions that has serious implications for pulmonary health. Increasing global temperatures influence respiratory health through extreme weather events, wildfires, prolonged allergy seasons, and worsening air pollution. Children, elderly patients, and patients with underlying lung disease are at elevated risk of complications from these effects of climate change. This paper summarizes the myriad ways in which climate change affects the respiratory health of patients at home and in outdoor environments and outlines measures for patients to protect themselves. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Hari M. Shankar, Mary B. Rice Source Type: research

Indoor Microbial Exposures and Chronic Lung Disease
Effects of environmental microbial exposures on human health have long been of interest. Microbes were historically assumed to be harmful, but data have suggested that microbial exposures can modulate the immune system. We focus on the effects of indoor environmental microbial exposure on chronic lung diseases. We found contradictory data in bacterial studies using endotoxin as a surrogate for bacterial exposure. Contradictory data also exist in studies of fungal exposure. Many factors may modulate the effect of environmental microbial exposures on lung health, including coexposures. Future studies need to clarify which me...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Molly Wolf, Peggy S. Lai Source Type: research

The Changing Nature of Wildfires
Catastrophic wildfires are increasing around the globe as climate change continues to progress. Another risk factor for large wildfires in the western United States is a legacy of fire suppression that has allowed overgrowth of underbrush and small trees in forests where periodic lightning-sparked wildfires are part of the natural ecosystem. Wildfire smoke contains CO2, CO, NOx, particulate matter, complex hydrocarbons (including polycyclic aromatic hydrocarbons), and irritant gases, including many of the same toxic and carcinogenic substances as cigarette smoke. The public need clear and consistent messaging to understand...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: John R. Balmes Source Type: research

Chest Imaging in the Diagnosis of Occupational Lung Diseases
Imaging plays a crucial role in the diagnosis and monitoring of occupational lung diseases (OLDs); however, the sensitivity and specificity of detection and diagnosis vary greatly depending on the imaging modality used. There is substantial overlap in appearance with non –occupation-related entities. OLDs should be considered in the differential even in the absence of a provided exposure history. Because many findings are not specific, a multidisciplinary approach is important in arriving at the diagnosis and will continue to be important as workplace-related pulm onary diseases evolve with changing industrial practi...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Lara Walkoff, Stephen Hobbs Source Type: research

Informatics Approaches for Recognition, Management, and Prevention of Occupational Respiratory Disease
Computer and information systems can improve occupational respiratory disease prevention and surveillance by providing efficient resources for patients, workers, clinicians, and public health practitioners. Advances include interlinking electronic health records, autocoding surveillance data, clinical decision support systems, and social media applications for acquiring and disseminating information. Obstacles to advances include inflexible hierarchical coding schemes, inadequate occupational health electronic health record systems, and inadequate public focus on occupational respiratory disease. Potentially transformative...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Philip Harber, Gondy Leroy Source Type: research

Health Disparities in Environmental and Occupational Lung Disease
This article focuses on disparities in disease prevalence, morbidity, and mortality for asthma, chronic obstructive pulmonary disease, pneumoconiosis, and lung cancer. Disparities are categorized by race, age, sex, socioeconomic status, and geographic region. Each category highlights differences in risk factors for the development and severity of lung disease. Risk factors include social, behavioral, economic, and biologic determinants of health (occupational/environmental exposures, psychosocial stressors, smoking, health literacy, health care provider bias, and health care access). Many of these risk factors are complex ...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Emily Brigham, Kassandra Allbright, Drew Harris Source Type: research

Respiratory Health Effects of Exposure to Cleaning Products
This article uses available evidence to give a broad but concise overview on what we know so far and how we can prevent the cleaning-associated respiratory publi c health burden. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Sara De Matteis, Steven Ronsmans, Benoit Nemery Source Type: research

Occupational Bronchiolitis
Occupational bronchiolitis is characterized by inflammation of the small airways, and represents a heterogeneous set of lung conditions that can occur following a range of inhalation exposures related to work. The most common clinical presentation includes insidious onset of exertional dyspnea and cough. Multiple reports in recent years have drawn attention to previously unrecognized risk factors for occupational bronchiolitis following exposures in several settings. Both current and past occupational exposures, including prior military deployment –related exposures, should be considered in patients undergoing evalua...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Randall J. Nett, R. Reid Harvey, Kristin J. Cummings Source Type: research

Silicosis: An Update and Guide for Clinicians
This overview provides an update on silicosis epidemiology with review of exposures and emerging trends in acute and accelerated silicosis in the twenty-first century. The silicosis epidemics in mining, denim sandblasting, and engineering stone industries are highlighted. Clinical presentations of silicosis and silica-related conditions such as autoimmune, kidney, and mycobacterial disease, as well as lung cancer, are discussed. Important aspects of the new OSHA 2017 Silica Standard are presented. This review also includes practical guidance for clinicians to address questions that may arise when evaluating silica-exposed ...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Silpa Krefft, Jenna Wolff, Cecile Rose Source Type: research

The Respiratory Risks of Ambient/Outdoor Air Pollution
Globally, exposure to ambient air pollutants is responsible for premature mortality and is implicated in the development and exacerbation of several acute and chronic lung disease across all ages. In this article, we discuss the source apportionment of ambient pollutants and the respiratory health effects in humans. We specifically discuss the evidence supporting ambient pollution in the development of asthma and chronic obstructive pulmonary disease and acute exacerbations of each condition. Practical advice is given to health care providers in how to promote a healthy environment and advise patients with chronic conditio...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Gary Adamkiewicz, Jahred Liddie, Jonathan M. Gaffin Source Type: research

Indoor Air Pollution and Respiratory Health
Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor ai...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Sarath Raju, Trishul Siddharthan, Meredith C. McCormack Source Type: research

Occupational Contributions to Interstitial Lung Disease
Historically well-recognized occupational threats such as coal workers pneumoconiosis, silicosis, and asbestosis remain important and are very likely underestimated in measures of global disease burden. Studies of occupational exposure related to idiopathic pulmonary fibrosis, the most common interstitial lung disease, are limited but there is moderate evidence for metal, wood, and stone dust being significant contributors. Vigilance is required to identify causes, such as hypersensitivity pneumonitis due to microbial contamination of metalworking fluid (now responsible for greater than 50% of occupational hypersensitivity...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Carl Reynolds, Johanna Feary, Paul Cullinan Source Type: research

Screening for Occupational Lung Cancer
Selected occupational populations are at the highest risk of lung cancer, because they smoke at increased rates and are concurrently exposed to workplace lung carcinogens. Low-dose computed tomography (CT) –based lung cancer screening has an enormous potential to reduce lung cancer mortality in these populations, as shown both in the lung cancer screening studies in the general population and in studies of workers at high risk of lung cancer. Pulmonologists can play a key role in identifying workers at high risk of lung cancer and ensuring that they are offered annual low-dose CT scans for early lung cancer detection...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Steven B. Markowitz, Brittany Dickens Source Type: research

Working in Smoke:
Wildland firefighters work on wildfire incidents all over the United States and perform arduous work under extreme work conditions, including exposure to smoke. Wildland fire smoke is a mixture of hazardous air pollutants. For assessing wildland firefighter exposure to smoke, most studies measured carbon monoixde (CO) and particulate matter and reported changes in lung health by measured lung function, airway responsiveness, and respiratory symptoms across individual work shifts and single fire seasons. All fire personnel should understand the hazards of smoke and develop ways to mitigate exposure to smoke. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Kathleen Navarro Source Type: research

Electronic Cigarettes
Electronic cigarettes (EC) are battery-operated devices that heat and aerosolize a liquid solution that typically contains nicotine. ECs have become commonly used among youth and may pose substantial risks of future addiction and health problems in this population. However, ECs are far less toxic per puff compared with combustible cigarettes, and as a result, might present an important harm reduction opportunity for cigarette smokers who cannot stop smoking by traditional means. The long-term health effects of ECs on individuals and the net effect on public health will remain unknown for many years. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Stephen R. Baldassarri Source Type: research

Master Clinician and Public Health Practitioner
Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contributing factors. Mastering occupational and environmental medicine clinical decision making requires specialized clinical skills. These skills include obtaining an appropriate work and exposure history; making an assessment of the magnitude and relevance of exposures and their contribution to a patient ’s r...
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Efia James, Brian Linde, Carrie A. Redlich Source Type: research

Occupational and Environmental Contributions to Lung Disease
It has been nearly a decade since the last issue of Clinics in Chest Medicine focused on Occupational and Environmental Lung Disease was published.1 In the ensuing years, we have witnessed appalling outbreaks of preventable pneumoconioses and come to recognize that the implications of climate change for respiratory health are myriad, complex, and already well underway.2 –4 In light of such developments and the advances in our understanding of the impact of work and environmental exposures on respiratory health, it is important to revisit the topic. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Kristin J. Cummings, Peggy S. Lai, Carrie A. Redlich Tags: Preface Source Type: research

Advances in Occupational and Environmental Lung Diseases
CLINICS IN CHEST MEDICINE (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Authors: Kristin J. Cummings, Peggy S. Lai, Carrie A. Redlich Source Type: research

Copyright
ELSEVIER (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Source Type: research

Contributors
KRISTIN J. CUMMINGS, MD, MPH (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Source Type: research

Contents
Kristin J. Cummings, Peggy S. Lai, and Carrie A. Redlich (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Source Type: research

Forthcoming Issues
Pulmonary Hypertension (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 3, 2020 Category: Respiratory Medicine Source Type: research

Chronic Obstructive Pulmonary Disease Pathogenesis
Chronic obstructive pulmonary disease (COPD) has been traditionally considered a self-inflicted disease caused by tobacco smoking. Current available evidence, however, indicates that the pathogenesis of COPD needs to consider the dynamic and cumulative nature of a series of environment (including smoking plus other exposures)-host interactions that eventually determine lung development, maintenance, repair, and aging. By doing so, these factors modulate the trajectory of lung function of the individual through life and the odds of developing COPD through different routes, which likely represent different forms of the disea...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Alvar Agusti, Rosa Faner Source Type: research

Epidemiology of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) affects about 300 million people worldwide, resulting in approximately 64 million disability-adjusted life years. Household air pollution affects almost 3 billion people worldwide and is a major risk factor for COPD. An estimated 25% to 45% of patients with COPD worldwide have never smoked. Fourteen percent of the overall COPD burden is attributable to occupational exposures. Rural populations are at higher risk for COPD than urban residents. African American never-smokers have a disproportionately high prevalence and Hispanic people have a low prevalence of COPD. (Source: Clini...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Lisa Ruvuna, Akshay Sood Source Type: research

Alpha-1 Antitrypsin Deficiency Associated COPD
Alpha-1 antitrypsin deficiency (AATD) was the first genetic risk factor for chronic obstructive pulmonary disease (COPD) described. In the more than 50  years since its description, the disease continues to provide insights into more common forms of COPD. Although AATD is caused by a single genetic variant, the clinical manifestations of disease include panacinar emphysema, airway hyperresponsiveness, and bronchiectasis. With improved molecular un derstanding of the mechanisms of disease pathogenesis and progression, new therapies in addition to intravenous augmentation therapy are on the horizon. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Charlie Strange Source Type: research

Prevention of Chronic Obstructive Pulmonary Disease
Governments could help prevent chronic obstructive pulmonary disease (COPD) by reducing smoking rates; for example, through tobacco sale restriction, increasing tobacco prices, reducing nicotine content, and banning smoking in public areas and workplaces. Smoking cessation in general, and in particular among patients with COPD, could be achieved through specific programs, including behavior modification and the use of nicotine replacement therapy, bupropion, or varenicline. Prevention and/or slowed COPD progression could be achieved by occupational exposure prevention; improved indoor/outdoor air quality; reduced cooking a...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Alberto Papi, Luca Morandi, Leonardo M. Fabbri Source Type: research

Long-Acting Bronchodilators for Chronic Obstructive Pulmonary Disease
Long-acting bronchodilators represent the mainstay of maintenance treatment of chronic obstructive pulmonary disease (COPD). This state-of-the-art review summarizes currently available data on the safety, efficacy, and clinical effectiveness of long-acting bronchodilators and describes their role in the management of COPD, as defined by current national and international guidelines. Data from extensive clinical trials and real-life studies have demonstrated that long-acting beta-2 agonists and long-acting muscarinic antagonists can safely reduce the frequency of exacerbations, alleviate symptoms, and improve quality of lif...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Alexander G. Mathioudakis, J ørgen Vestbo, Dave Singh Source Type: research

Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease
Inhaled corticosteroids (ICSs), when used in combination with long-acting bronchodilators, reduce the risk of exacerbations and improve health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with bronchodilator or ICS therapy alone. Potential side effects of ICSs include adverse effects on glycemic control, bone density, cataract formation, skin changes, oral candidiasis, and pulmonary infections. Pneumonia is observed at increased rates in COPD patients, in particular those with greater airflow limitation, low body mass index, advanced age, and male gender, and ICSs may incre...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Takudzwa Mkorombindo, Mark T. Dransfield Source Type: research

Systemic Medications in Chronic Obstructive Pulmonary Disease
Inhaled therapy remains the cornerstone of chronic obstructive pulmonary disease pharmacologic care, but some systemic treatments can be of help when the burden of the disease remains high. Azithromycin, phosphodiesterase-4 inhibitors, and mucoactive agents can be used in such situations. The major difficulty remains in the identification of the optimal target populations. Another difficulty is to determine how these treatments should be positioned in the global treatment algorithm. For instance, should they be prescribed in addition to other antiinflammatory agents or should they replace them in some cases? Research is on...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Nicolas Roche Source Type: research

Biomarkers in Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a highly heterogeneous disease with limited adequate treatments. Biomarkers —which may relate to disease susceptibility, diagnosis, prognosis, or treatment response—are ideally suited to dissecting such a complex disease and form a critical component of the precision medicine paradigm. Not all potential candidates, however, make good biomarkers. To date, only plasma fib rinogen has been approved by regulatory bodies as a biomarker of exacerbation risk for clinical trial enrichment. This review outlines some of the challenges of biomarker research in COPD and highl...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Stephen Milne, Don D. Sin Source Type: research

Multimorbidity in Patients with Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a complex disease manifested primarily as airflow limitation that is partially reversible as confirmed by spirometry. COPD patients frequently develop systemic manifestations, such as skeletal muscle wasting and cachexia. COPD patients often develop other comorbid diseases, such as ischemic heart disease, heart failure, osteoporosis, anemia, lung cancer, and depression. Comorbidities complicate management of COPD and need to be evaluated because detection and treatment have important consequences. Novel approaches aimed at integrating the multiple morbidities seen in COPD and...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Miguel Divo, Bartolome R. Celli Source Type: research

Pulmonary Rehabilitation
Pulmonary rehabilitation (PR) is an essential intervention in the management of patients with chronic obstructive pulmonary disease. To guide health care professionals in the implementation and evaluation of a PR program, this article discusses the current key concepts regarding exercise testing, prescription, and training, as well as self-management intervention as essential parts of PR and post-rehabilitation maintenance. Moreover, new approaches (alternative forms of organization and delivery, tele-rehabilitation, exercise adjuncts) and unique and challenging situations (patients experiencing acute exacerbations, advanc...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Jean Bourbeau, Sebastien Gagnon, Bryan Ross Source Type: research

Lung Function Testing in Chronic Obstructive Pulmonary Disease
Lung function testing has undisputed value in the comprehensive assessment and individualized management of chronic obstructive pulmonary disease, a pathologic condition in which a functional abnormality, poorly reversible expiratory airway obstruction, is at the core of its definition. After an overview of the physiologic underpinnings of the disease, the authors outline the role of lung function testing in this disease, including diagnosis, assessment of severity, and indication for and responses to pharmacologic and nonpharmacologic interventions. They discuss the current controversies surrounding test interpretation wi...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: J. Alberto Neder, Juan Pablo de-Torres, Kathryn M. Milne, Denis E. O'Donnell Source Type: research

Assessing Symptom Burden
Evaluating symptoms is a central part of the chronic obstructive pulmonary disease (COPD) assessment system as suggested by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Considering the pros and cons of all currently available tests, GOLD suggests using primarily the modified Medical Research Council dyspnea scale or the COPD Assessment Test. Based on the test results, patients are categorized as having a low or high level of symptoms. This level then becomes one of the 2 dimensions of the ABCD grading system, which was designed to match the best initial treatment option to the individual patient &rsqu...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Claus F. Vogelmeier, Peter Alter Source Type: research

What Is Asthma Chronic Obstructive Pulmonary Disease Overlap?
The term asthma chronic obstructive pulmonary disease (COPD) overlap (ACO) has been popularized to describe people who simultaneously have features of both diseases. Analysis of the basis of disease classification and comparison of the clinical, pathophysiological, and therapeutic features of asthma and COPD concludes that it is not useful to use the term ACO. Rather, it is important to make the individual diagnoses, recognizing that both diseases may coexist. If a concurrent diagnosis of COPD is suspected in people with asthma, pharmacotherapy should primarily follow asthma guidelines, but pharmacologic and nonpharmacolog...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: David M.G. Halpin Source Type: research

Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are episodes of symptom worsening which have significant adverse consequences for patients. Exacerbations are highly heterogeneous events associated with increased airway and systemic inflammation and physiological changes. The frequency of exacerbations is associated with accelerated lung function decline, quality of life impairment and increased mortality. They are triggered predominantly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation. A proportion of patients appear to be more susceptible to exacerb...
Source: Clinics in Chest Medicine - August 13, 2020 Category: Respiratory Medicine Authors: Andrew I. Ritchie, Jadwiga A. Wedzicha Source Type: research