Incidence of chronic obstructive pulmonary disease in people with HIV in Ontario, 1996-2015: a retrospective population-based cohort study.

BACKGROUND: Because of high smoking rates and HIV-related factors, people with HIV may be at high risk for chronic obstructive pulmonary disease (COPD); however, population-based estimates of the incidence of COPD among people with HIV are lacking, particularly for women. We compared the incidence of COPD among Ontario adults aged 35 years or more with and without HIV between Jan. 1, 1996, and Dec. 31, 2015. METHODS: We conducted a population-based study using Ontario's health administrative databases. We compared the incidence of COPD between people with and without HIV using standardized incidence ratios and generalized estimating equations with a log link function. RESULTS: We identified 1849 people with HIV and 1 168 727 HIV-negative people who were newly diagnosed with COPD between 1996 and 2015. People with HIV were younger than HIV-negative people (mean age 49.7 [standard deviation 10.4] yr v. 62.2 [standard deviation 14.8] yr; standardized difference 0.98). Rates of COPD were higher among people with HIV than among HIV-negative people (10.4 v. 9.0 cases per 1000 person-years; standardized incidence ratio 1.16, 95% confidence interval [CI] 1.10 to 1.21; adjusted rate ratio 1.34, 95% CI 1.27 to 1.41). In sex-stratified analyses, rates of COPD were higher among men with HIV (adjusted rate ratio 1.32, 95% CI 1.24 to 1.40) and women with HIV (adjusted rate ratio 1.54, 95% CI 1.37 to 1.72) than among men and women without HIV. In a sensitivity analysis, smoking explained observed differences in COPD incidence. INTERPRETATION: People with HIV had higher rates of incident COPD than HIV-negative people. This may reflect the disproportionately higher prevalence of smoking among the former.

Enfermedad Pulmonar Obstructiva Crónica en el Siglo XXI - Optimismo basado en evidencia / Chronic Obstructive Pulmonary Disease in the 21st Century - Evidence-based optimism

There are increasingly more data on the prevalence and distribution of Chronic Obstructive Pulmonary Disease (COPD) from around the world. COPD is predicted to be the third most frequent cause of death in the world by 2020. COPD is mainly caused by chronic tobacco smoking, which induces important changes in both the airways and lung parenchyma. COPD is a progressive, disabling condition that ultimately ends in respiratory failure and death. Is a multicomponent disease, there is evidence that systemic inflammation and extrapulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD has been associated with a nihilistic attitude. On the basis of current evidence, this nihilistic attitude is totally unjustified. The disease must be viewed through the lens of a new paradigm: COPD is not only preventable but also treatable. The past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientific evidence now documents the efficacy of various therapies for symptoms and exacerbations. It is clear that many patients with COPD can benefit from aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. In addition, basic and clinical scientists have now identified cells, mechanisms, and molecules that appear to play key roles in disease pathogenesis. Additional novel treatments are on the horizon and the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health. The good news about COPD is to increase awareness of the disease. COPD is now viewed under a new paradigm as preventable and treatable.

Early History of Chronic Obstructive Pulmonary Disease 1808-1980.

COPD has become a more popular research area in the last 3 decades, yet the first clear descriptions of acute and chronic bronchitis were in 1808. This brief history, comprehensively referenced, leads us through the early developments in respiratory physiology and their applications. It emphasises the early history of chronic bronchitis and emphysema in the 19(th) and early 20(th) centuries, long before the dominant effects of cigarette smoking emerged. This remains relevant to developing countries today.

Incidence and prevalence of chronic obstructive pulmonary disease among aboriginal peoples in Alberta, Canada.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort. METHODS: We used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors. RESULTS: Compared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups. CONCLUSIONS: We found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups.

Occupation and chronic obstructive pulmonary disease (COPD).

INTRODUCTION: There is growing interest in preventable, non-smoking causes of chronic obstructive pulmonary disease (COPD), among which are chronic exposures to respiratory irritants in the workplace. SOURCES OF DATA: Reviews of occupational COPD in specific occupations and industries and in general populations; supplemented with other or more recently published material. AREAS OF AGREEMENT: There is good evidence for an increased risk of COPD from certain specific exposures (coal mine dust, silica, welding fume, textile dust, agricultural dust, cadmium fume). AREAS OF CONTROVERSY: Less clear is the causal role of non-specific dusts or fumes/gases in general populations where the available literature is notably uncritical. GROWING POINTS: Other specific exposures, such as diesel fume; interactions between specific exposures and cigarette smoking; the development of safe working limits. AREAS TIMELY FOR DEVELOPING RESEARCH: Occupations with large numbers of exposed employees, particularly in low-income countries.

[Concept of COPD, from past to the present].

The clinical concept of COPD initially started in conjunction with American Emphysema and British Bronchitis in CIBA Guest Symposium in 1958. JC Hogg, et al. recognized the peripheral airways as the major site of airflow obstruction in COPD in 1968. Thirty-six years later in 2004, JC Hogg, et al. described the pathological nature of small-airway obstruction in COPD. The GOLD project provided state-of-the-art information about COPD in 2001, in which it is stated that the chronic airflow limitation characteristic of COPD is caused by a mixture of small airway disease and parenchymal destruction. Cigarette smoke may accelerate the aging of lung or worsen aging-related events in lung by defective resolution of inflammation. Accelerated decline in lung function is recognized to occur in asthma, especially in those with asthma who smoke. With increasing age, there was a greater increase in the proportion of patients with overlapping COPD and asthma.

[COPD - a historical review, current management and research perspectives]. / COPD - Historischer Uberblick, aktuelles Management, Forschungsperspektiven.

The term COPD which comprises chronic obstructive bronchitis and emphysema, was first defined in 1964. Key milestones to the understanding of the etiopathology of COPD were the discovery of the association between tobacco consumption and the development of chronic bronchitis as well as the discovery of the role of a protease-antiprotease imbalance leading to emphysema. The assessment of functional impairement of patients with COPD was established in the 1960s and the quantification and localisation was predominantly explored in the 1980s. The management of COPD comprises preventative measures (e.g. smoking cessation, vaccination against influenza, reduction of occupation hazards), medical therapies (bronchodilators, corticosteroids), non-pharmacological therapies (exercise training, patient education, physiotherapy) as well as surgical options. The prevention and efficiency management of exacerbations are of particular importance. Optimal management of COPD has to take impact of the disease on other organs into account. The future of COPD-related research lies in the development of international and national networks to facilitate the analysis of genetic factors on the pathology of COPD.

The nature and causes of chronic obstructive pulmonary disease: a historical perspective. The Christie Lecture 2007, Chicago, USA.

Chronic obstructive pulmonary disease (COPD) is the currently favoured name for the diseases formerly known as emphysema and bronchitis. COPD has been recognized for more than 200 years. Its cardinal symptoms are cough, phlegm and dyspnea, and its pathology is characterized by enlarged airspaces and obstructed airways. In the 19th century, the diagnosis of COPD depended on its symptoms and signs of a hyperinflated chest, and reduced expiratory breath sounds. The airflow obstruction evident on spirometry was identified in that century, but did not enter into clinical practice. Bronchitis, and the mechanical forces required to overcome its obstruction, was believed to be responsible for emphysema, although the inflammation present was recognized. The causes of bronchitis, and hence emphysema, included atmospheric and domestic air pollution, as well as dusty occupations. Cigarette smoking only became recognized as the dominant cause in the 20th century. The lessons learned of the risks for COPD in 19th-century Britain are very pertinent to the world today.

One hundred years of chronic obstructive pulmonary disease (COPD).

Chronic obstructive pulmonary disease (COPD) is an increasing health problem and one of the leading causes of morbidity and mortality worldwide, but knowledge about its pathogenesis has increased substantially in recent years. The disease results from interaction between individual risk factors (like enzymatic deficiencies) and environmental exposures to noxious agents, like cigarette smoking, occupational dusts, air pollution and infections in childhood. The main mechanisms that may contribute to airflow limitation in COPD are fixed narrowing of small airways, emphysema and luminal obstruction with mucus secretions. COPD is characterised by a chronic inflammatory process in the pulmonary tissue, with a pattern different from bronchial asthma, associated with extrapulmonary effects and is considered now a complex, systemic disease. Optimal therapeutic targeting of COPD depends on a clear understanding of the precise mechanisms of these complex processes and on early and correct evaluation of disease severity. A combination of pharmacological and non-pharmacological approaches is used to treat COPD. Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnoea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, non-invasive mechanical ventilation offers new alternatives for patients with acute or chronic failure.

Hospital Josefina Martínez: una breve reseña histórica / Hospital Josefina Martinez: a brief historical review

El Hospital Josefina Martínez (HJM) es una institución privada, que nació de la disposición testamentaria de Doña Josefina Martínez de Ferrari como un Hospital para niños enfermos de tuberculosis provenientes de familias con escasos recursos económicos. Luego de hospitalizarse el último caso de tuberculosis y gracias a la disminución significativa de la tasa de ésta enfermedad en nuestro medio, se generaron cambios sustanciales en los objetivos iniciales, derivando su atención hacia otras condiciones respiratorias. En la actualidad, el HJM se especializa en el cuidado, manejo y control de enfermedades neuromusculares, fibrosis quística, displasia broncopulmonar grave, bronquiolitis obliterante post infecciosa, traqueotomizados -entre otras- provenientes de diversos hospitales base del país, existiendo cada vez más pacientes ventilados bajo la modalidad de invasiva y no invasiva, como parte del Programa Nacional de Asistencia Ventilatoria domiciliaria.

Surgical options for patients with COPD: sorting out the choices.

Surgical procedures designed to improve pulmonary function and quality of life of patients with advanced emphysema have been attempted for more than a century. Of the many attempted procedures, only giant bullectomy, lung transplantation, and lung-volume-reduction surgery have withstood the test of time and are currently being practiced. This article reviews each of these procedures and also develops a rational approach to selecting appropriate candidates for these 3 interventions.

The history of COPD.

The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years. The stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose. Knowledge of the pathogenesis, course and prognosis, and new approaches to therapy have dramatically improved our understanding of this important clinical entity. Smoking cessation improves the early course of disease. Long-term oxygen improves the length and quality of life in selected patients with hypoxemia. Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.

Evaluación del conocimiento sobre efecto del cigarrillo en internas fumadoras. Pereira 2004 / Evaluation of Inpatient Smokers’ Knowledge of the Effect of Cigarettes. Pereira 2004

El objetivo general de este estudio fue evaluar el nivel de conocimiento sobre los daños causados por el cigarrillo, en las internas que fuman en un Establecimiento Penitenciario y Carcelario de Mujeres de Pereira, durante el segundo semestre de 2004. Inicialmente se identificaron y cuantificaron las condenadas fumadoras, obteniendo como población estudio un total de 34 internas entre las 149 presentes en la institución. Luego se aplicó una encuesta semiestructurada, la cual permitió recolectar las variables: continuas (nombre, edad etc.) y discontinuas, divididas en variables dicotómicas (procedencia, ¿tiene hijos?) y discretas (escolaridad, cambios en el organismo desde que comenzó a fumar). La información recolectada se condensó en una base de datos en epiinfo, la cual se analizó en forma univariada; posteriormente se realizó análisis bivariado, entre las variables más representativas. Las principales limitaciones en el desarrollo del trabajo fueron la falta de cooperación de las internas, algunas de las cuales presentaron una actitud apática y desconfiada alterando los datos de la encuesta y ocasionando de esta manera sesgos de información, además del horario para la recolección de información, ya que se cruzaba con otras actividades realizadas por ellas o por los estudiantes. El 91 por cien de las internas conoce que el hábito del cigarrillo trae efectos adversos para la salud; de ese 91 por cien, 52 por cien cree que causa cáncer de pulmón; el 15 por cien que causa ‘enfermedad en los pulmones’. El análisis bivariado mostró que a mayor edad, mayor es el conocimiento acerca de los efectos que el cigarrillo ejerce sobre la salud y la relación con el número de cigarrillos consumidos diariamente. Las internas tienen algún conocimiento de los efectos adversos del cigarrillo, porque la mayoría aceptó la relación de éste con enfermedades; pero la concordancia es básicamente para problemas respiratorios, más no para alteraciones sistémicas; además creen que to...

[Definition of chronic obstructive disease].

COPD is a name proposed by two American doctors, M.H. Williams and N.S. Seriff, to describe a disease entity combining chronic bronchitis and pulmonary emphysema, manifested in patients as an obstructive ventilatory disorder with a main symptom of chronic dyspnea. Since the 1970s, COPD has been considered a smokers' disease brought on chiefly by the chronic stimulation of tobacco smoke. In 2001, the GOLD guideline indicated that COPD should not refer to a disease combining chronic bronchitis and pulmonary emphysema, but rather to a disease state characterized by an airflow limitation that is not fully reversible. Nonetheless, problems still remain in defining this disease entity.

[The relationship between asthma and chronic obstructive and restrictive pulmonary diseases; lessons from the past century]. / De relatie tussen astma en chronisch obstructieve en restrictieve longziekten; lessen uit de afgelopen eeuw.

The so-called 'Dutch hypothesis' (Fletcher) which describes chronic obstructive (restrictive) pulmonary disease (CO(R)PD) as a consequence of complicated childhood asthma (from 1900-1960) is well-founded. It can explain many aspects of the ever changing pattern of asthma and COPD in the Western world. Severe respiratory disease in children during the first part of the 20th century was primarily the result of respiratory complications of measles and whooping cough, and caused a high mortality in children below the age of two years. Gradually more children survived and a picture of the complications was formed: chronic bronchitis and bronchiectasis. In 1939 it was suggested that this happened mainly in children with asthmatic predisposition and this pattern was documented in detail in the post World War II period. After 1970 the complications virtually disappeared as a result of vaccination and improved therapy. Consequently, bronchiectasis and cor pulmonale became rare and CO(R)PD became COPD, the old-age form of asthma. There has also been a marked increase in asthma after childhood over the past 30 years. The double role of obstruction-provoking and anti-obstructive (and asthma-masking) infections plays an important role in this respect. The old picture from the fifties in the Western world still prevails in developing countries. Prevention of this 'old COPD' must consist of vaccination against measles and whooping cough (and possibly also against respiratory syncytial virus), and treatment of asthma.

COPD in perspective.

In the last 200 years or so, the recognition, diagnosis, and understanding of the pathogenesis of COPD have evolved considerably. Over the past few decades, various definitions of COPD and its "components" also have developed. Despite this, however, the treatment options for patients with this relentlessly progressive disorder are relatively limited. In the mid-19th century, the introduction of the spirometer yielded a powerful tool for the diagnosis of COPD. The currently available small, cheap spirometers hold great promise to help patients and their physicians closely monitor lung function. Early recognition of the close associations among emphysema and, more recently, small airways disease, and impaired airflow is discussed. This review also stresses the importance of the identification of COPD in its initial stages and the early onset of appropriate treatment. The therapy for COPD has changed in the last 40 years. Drug therapies in the 1960s included potassium iodide and ephedrine. Corticosteroids were not used, and oxygen therapy and exercise were actually contraindicated. Modern therapy for COPD is now more systematic and includes the use of bronchodilators and corticosteroids to improve airflow, in addition to oxygen therapy, pulmonary rehabilitation and, in selected patients, lung volume reduction surgery. The causal link between the chronic inhalation of tobacco smoke and COPD is beyond doubt, and smoking cessation remains the most important goal for patients. It is hoped that new, more effective therapies will soon be available for the treatment of this disabling disorder to provide improvement in symptoms and patient quality of life and to reduce or stop the rate of disease progression and mortality in patients with COPD.