Purpose of review: Chronic obstructive pulmonary disease (COPD) is often considered to be a disease in which an inevitable decline in lung function results in increasing dyspnea and deteriorating quality of life. This review summarizes recent data that calls this classic paradigm into question. Studies evaluating the effects of chronic sputum production, physical activity, and inhaled medications on quality of life and prognosis are also discussed.

Recent findings: Chronic sputum production and level of dyspnea contribute at least as much to impairment of quality of life and prognosis as does abnormal lung function. An accelerated decline in FEV1 occurs in only half of the patients who develop COPD. Current pharmacotherapy has been shown to moderate disease progression and quality of life, although the effects are lost when inhaled corticosteroids are discontinued. Declining physical activity begins early in the course of COPD, but increasing activity levels result in improved quality of life and a slower decline in lung function.

Summary: Symptoms and activity levels are as important as measuring FEV1 in determining disease severity, quality of life, and prognosis of COPD. Therapies exist that moderate the course of the disease, and small sustained increases in physical activity may slow physical deterioration and improve health-related quality of life.

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Purpose of review: Chronic obstructive pulmonary disease (COPD) is a widespread disease process with important clinical and economic implications. This review will summarize new pharmacotherapy for the treatment of COPD.

Recent findings: Several recent clinical trials have led to the approval of new inhaler therapies for COPD. Many of these are specifically targeting combination long-acting β-agonists and long-acting muscarinic antagonists for late stage COPD.

Summary: Several new bronchodilators are available on the market, especially in combination form. The new drug combinations have positive data though clinical relevance, and comparisons to available and well established therapies are still needed. Specifically, translating improved forced expiratory volume into meaningful clinical outcomes remains challenging.

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Purpose of review: Occupational exposures in the agricultural industry are associated with numerous lung diseases, including chronic obstructive pulmonary disease, asthma, hypersensitivity pneumonitis, lung cancer, and interstitial lung diseases. Efforts are ongoing to ascertain contributing factors to these negative respiratory outcomes and improve monitoring of environmental factors leading to disease. In this review, recently published studies investigating the deleterious effects of occupational exposures in the agricultural industry are discussed.

Recent findings: Occupational exposures to numerous agricultural environment aerosols, including pesticides, fungi, and bacteria are associated with impaired respiratory function and disease. Increases in certain farming practices, including mushroom and greenhouse farming, present new occupational exposure concerns. Improved detection methods may provide opportunities to better monitor safe exposure levels to known lung irritants.

Summary: In the agricultural industry, occupational exposures to organic and inorganic aerosols lead to increased risk for lung disease among workers. Increased awareness of respiratory risks and improved monitoring of agricultural environments are necessary to limit pulmonary health risks to exposed populations.

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Purpose of review: The review will provide an update on the pathophysiology and studies of inflammation associated with the asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and the mechanism(s) responsible for persistent expiratory airflow limitation in never-smoked asthma patients who develop loss of lung elastic recoil consistent with an asthma–COPD clinical phenotype (ACOS in nonsmokers). Recent findings: Patients with a clinical diagnosis of ACOS have more frequent respiratory exacerbations and hospitalizations than COPD patients without ACOS. ACOS patients should be treated with inhaled corticosteroids, short and long-acting β2-agonist, and long-acting muscarinic receptor antagonist. Biomarker work suggests that a molecular phenotype of ACOS (e.g., elevated markers of eosinophilic or type 2 inflammation) incompletely corresponds to clinical phenotypes. Recently, we reported sentinel observation of unsuspected mild diffuse centrilobular emphysema in never-smoked asthma patients at autopsy, despite mild changes in lung computed tomography and normal diffusing capacity.

Summary: Recent studies have shown that subgroups of COPD and asthma patients may have overlapping immune responses. Never-smoked asthma patients may have persistent expiratory airflow limitation because of loss of lung elastic recoil. This may be because of unsuspected centrilobular emphysema detected at autopsy, and not easily diagnosed on lung computed tomography and diffusing capacity.

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