Other systemic manifestations of chronic obstructive pulmonary disease

Ambient Air Pollution and Morbidity in Chinese

The rapid economic growth in China is coupled with a severe ambient air pollution, which poses a huge threat to human health and the sustainable development of social economy. The rapid urbanization and industrialization over the last three decades have placed China as one of countries with the greatest disease burden in world. Notably, the prevalence rate of chronic noncommunicable diseases (CND), including respiratory diseases, CVD, and stroke, in 2010 reaches 16.9%. The continuous growth of the incidence of CND urgent needs for effective regulatory action for health protection. This study aims to evaluate the impact of rapid urbanization on status of ambient air pollution and associated adverse health effects on the incidence and the burden of CND and risk assessment. Our findings would be greatly significant in the prediction of the risk of ambient air pollution on CND and for evidence-based policy making and risk management in China.

Acute exacerbations of chronic obstructive pulmonary disease in the emergency department

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPDs) are a common presentation to emergency departments and are an important cause of respiratory failure. This article discusses the disease process and diagnosis of COPD and AECOPD. A further in-depth discussion is undertaken of evidence-based treatments, palliation, and disposition of patients who present to emergency departments with AECOPD.

Bibliography. Current world literature

This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.

Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable?

PURPOSE OF REVIEW

Systemic corticosteroids are strongly recommended in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD). As COPD patients are usually elderly and are relatively immobile, side effects of systemic corticosteroids frequently outweigh their beneficial effects. On the contrary, nebulized corticosteroid solutions have a negligible systemic side-effect profile. In this review, as an alternative to systemic corticosteroids, the place of nebulized corticosteroids in exacerbation periods of COPD was summarized.

RECENT FINDINGS

The number of trials in the literature is increasing. Regarding the available data, high dose nebulized budesonide was found as effective as systemic corticosteroids in exacerbations of COPD. The side-effect profile, blood glucose level in particular, is better for nebulized budesonide.

SUMMARY

Findings from recent studies are giving a positive impression on the role of high dose nebulized budesonide in exacerbations of COPD. However, larger and statistically high powered trials testing different types of nebulized corticosteroid solutions with varying dosages are still lacking. Before recommending the routine use of nebulized corticosteroids in exacerbations, present findings need to be confirmed with further studies of high quality.

Prevalence of hepatitis C virus infection in patients with COPD

Some studies have suggested that chronic hepatitis C virus (HCV) infection may induce an accelerated decline of forced expiratory volume in 1 second (FEV1). We performed a cross-sectional study to determine the prevalence of HCV infection in a sample of chronic obstructive pulmonary disease (COPD) patients and in a control group of blood donors. The clinical characteristics of HCV-positive and HCV-negative patients were compared. Anti-HCV antibody was determined and confirmed by HCV-RNA. The prevalence of HCV infection in COPD patients was 7·5% (95% CI 6·52–8·48) and in blood donors was 0·41% (95% CI 0·40–0·42). The HCV-positive patients had a lower FEV1 (34·7±8·6%) and a higher BODE index (median=6) than HCV-negative patients (42·7±16·5%, median=4, respectively) (P=0·011 and 0·027, respectively). Our results suggest a high prevalence of chronic HCV infection in patients with COPD in comparison with the blood donors. HCV-positive patients have a more severe disease.