The present study aimed to explore the prevalence of pre-capillary pulmonary hypertension (PH) and characterize hemodynamic vascular responses to physical exercise in COPD outpatients, where LV dysfunction and co-morbidities were excluded.

Ninety-eight patients with COPD underwent right heart catheterization at rest and during supine exercise. Mean pulmonary artery pressure (mP(pa)), pulmonary wedge pressure (Ppaw) and cardiac output (CO) were measured at rest and during exercise. Exercise induced increase in mP(pa) was interpreted relative to increase in blood flow, mP(pa)/CO, and workload, mP(pa)/W. Pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC) were calculated.

PH was defined as mP(pa)-rest≥25 and Ppaw-rest<15&emsp14;mmHg.Prevalence of PH was 5, 27 and 53 % in GOLD stages II, III and IV, respectively. The absolute exercise induced rise in mP(pa) did not differ between PH and no-PH. Patients without PH showed similar abnormal hemodynamic responses to exercise as the PH group, with increased PVR, reduced PAC and steeper slopes for mP(pa)/CO and mP(pa)/W.

Exercise revealed abnormal physiologic hemodynamic responses in the majority of the COPD patients. The future definition of PH on exercise in COPD should rely on the slope of mP(pa) related to CO or workload rather than the absolute values of mP(pa).

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Respiratory allergies represent a global and public health problem, due to their prevalence (still increasing), morbidity, impact on the quality of life and costs for the society. They mainly concern rhinitis (or rhinoconjunctivitis) and asthma.

The diagnosis of allergy is dependent on a history of symptoms on exposure to an allergen together with the detection of allergen-specific IgE. Accurate diagnosis of allergies opens up therapeutic options that are otherwise not appropriate, such as allergen immunotherapy and allergen avoidance, that are prescribed following a stepwise approach. It has been a century since the first trial in specific immunotherapy was performed and this still remains the only disease modifying treatment for allergic individuals.

In terms of route of administration, sublingual immunotherapy represents a good alternative to subcutaneous immunotherapy, considering its proven efficacy and better safety profile.

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PURPOSE OF REVIEW: Asthma and rhinitis are commonly associated and they influence their respective control. New observations have contributed to better understand how to assess those conditions and how they influence each other.

RECENT FINDINGS: Recent studies found that not only the intensity, but also the duration of rhinitis could be correlated with the development of asthma and possibly its remission. The measure of exhaled nitric oxide (FeNO) has been used to show the presence of lower airway inflammation in rhinitic patients, with or without asthma. Furthermore, it has been shown that allergic rhinitis could affect asthma control in children as in adults, and consequently suggested that allergic rhinitis and asthma should be concomitantly approached in regard to their diagnosis and treatment. Additional observations showed improvements in various asthma outcomes with the treatment of rhinitis.

SUMMARY: These new data confirm the strong link between asthma and rhinitis, the importance of their interactions, and the need to identify and treat rhinitis adequately in asthmatic patients.

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PURPOSE OF REVIEW: Air pollution has been increasingly associated with diverse adverse health outcomes, including airway diseases. Data suggest that gene-environment interactions are important in this context. However, evidence regarding causal effects of exposure and development of allergic conditions specifically remains immature. We review the developments of the past 18 months regarding air pollution, genetics and epigenetics, and allergy.

RECENT FINDINGS: Conflicting evidence for air pollution as causative in the development of allergic disease persists. However, recent data support the associations between long-term exposure to traffic-related pollutants and newly developed sensitization in children. Studies from India and China demonstrate the global burden of health-related costs attributed to air pollutants and allergic diseases. The effect of exposure seems to be modified by coexposures of allergens as well as genetic variants, particularly those moderating response to oxidative stress. Potential links between exposures and epigenetic (DNA methylation) changes with consequences for disease development are also reinforced.

SUMMARY: Data over the past 18 months support prior literature that air pollutants cause exacerbation, and possibly onset, of allergic disease. Regarding the onset of asthma specifically, the evidence of causality has grown significantly, but it remains difficult to separate allergic from nonallergic asthma. Effect of modification by genetic variants and epigenetic changes warrants further study.