The dominant theory of Hippocrates was that of the four humours—that when the four humours were in balance health prevailed. Therefore, the main goal of the medical therapy was to restore humoral equilibrium.

We read with great interest the article by Hou et al,1 where an imbalance between protective and detrimental subgroups of T regulatory (Treg) cells in patients with COPD is showed. On the contrary with previous studies reporting no significant differences in CD4 foxp3+ T cells between patients with COPD and smokers,2 authors performed an elegant series of experiments and dissected Treg cells into three distinct subpopulations, denominated resting, active and cytokine-secreting Treg cells based on the intensity of foxp3+ expression and the secretion of proinflammatory cytokines including interferon and interleukin 17. As expected, subgroup analysis revealed an imbalance between different Treg subsets, including a downregulation of suppressive Treg cells and an...

The COPDGene Study1 is providing important new information about the natural history of several chronic obstructive pulmonary disease (COPD) phenotypes.2 This multicentre study enrolled a large number of current and former smokers with a wide range of spirometry results (from normal to very severe airflow obstruction), carefully characterised them during their baseline examination, and has been following them for several important outcome measures.

The key phenotypes include

• chronic airflow obstruction (CAO) defined by a low post-bronchodilator forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC),
• high-resolution CT (HRCT)-defined emphysema (low attenuation at maximal inhalation, total lung capacity),
• hyperinflation or gas trapping on HRCT, defined as low attenuation of the lungs at low lung volume (around functional residual capacity),
• and airway inflammation (defined by bronchial wall thickening on HRCT, also known as bronchiectasis).

A comparison of two of these phenotypes—CAO versus...

Promotion of Lung Health: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases.

Ann Am Thorac Soc. 2014 Apr;11 Suppl 3:S125-38

Authors: Camargo CA, Budinger GR, Escobar GJ, Hansel NN, Hanson CK, Huffnagle GB, Buist AS

Abstract
Lung-related research primarily focuses on the etiology and management of diseases. In recent years, interest in primary prevention has grown. However, primary prevention also includes "health promotion" (actions in a population that keep an individual healthy). We encourage more research on population-based (public health) strategies that could not only maximize lung health but also mitigate "normal" age-related declines-not only for spirometry but across multiple measures of lung health. In developing a successful strategy, a "life course" approach is important. Unfortunately, we are unable to achieve the full benefit of this approach until we have better measures of lung health and an improved understanding of the normal trajectory, both over an individual's life span and possibly across generations. We discuss key questions in lung health promotion, with an emphasis on the upper (healthier) end of the distribution of lung functioning and resiliency and briefly summarize the few interventions that have been studied to date. We conclude with suggestions regarding the most promising future research for this important, but largely neglected, area of lung research.

PMID: 24754821 [PubMed - in process]

Asthma: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases.

Ann Am Thorac Soc. 2014 Apr;11 Suppl 3:S139-45

Authors: Jackson DJ, Hartert TV, Martinez FD, Weiss ST, Fahy JV

Abstract
Asthma is a common disease with enormous public health costs, and its primary prevention is an ambitious and important goal. Understanding of how host and environmental factors interact to cause asthma is incomplete, but persistent questions about mechanisms should not stop clinical research efforts aimed at reducing the prevalence of childhood asthma. Achieving the goal of primary prevention of asthma will involve integrated and parallel sets of research activities in which mechanism-oriented studies of asthma inception proceed alongside clinical intervention studies to test biologically plausible prevention ideas. For example, continued research is needed, particularly in young children, to uncover biomarkers that identify asthma risk and provide potential targets of intervention, and to improve understanding of the role of microbial factors in asthma risk and disease initiation. In terms of clinical trials that could be initiated now or in the near future, we recommend three interventions for testing: (1) preventing asthma through prophylaxis against respiratory syncytial virus and human rhinovirus infections of the airway; (2) immune modulation, using prebiotics, probiotics, and bacterial lysates; and (3) prevention of allergen sensitization and allergic inflammation, using anti-IgE. These interventions should be tested while other, more universal prevention measures that may promote lung health are also investigated. These potential universal lung health measures include prevention of preterm delivery; reduced exposure of the fetus and young infant to environmental pollutants, including tobacco smoke; prevention of maternal and child obesity; and management of psychosocial stress.

PMID: 24754822 [PubMed - in process]