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Non-coding RNAs in the pathogenesis of COPD

A large part of the human genome is transcribed in non-coding RNAs, transcripts that do not code for protein, including microRNAs (miRNAs) and long non-coding RNAs (lncRNAs). MiRNAs are short single-stranded RNA molecules that negatively regulate gene expression at the post-transcriptional level. They play an important regulatory role in many biological processes. Consequently, altered expression of these non-coding RNAs has been shown to lead to inflammation and disease. In contrast, lncRNAs, can both enhance or repress the expression of protein-coding genes. COPD is typically caused by tobacco smoking and leads to a progressive decline in lung function and a premature death. Exaggerated pulmonary inflammation is a hallmark feature in this disease, leading to obstructive bronchiolitis and emphysema. In this review, we discuss the miRNA expression patterns in lungs of patients with COPD and in mouse models and we highlight various miRNAs involved in COPD pathogenesis. In addition, we briefly discuss a specific lncRNA that is upregulated upon cigarette smoke exposure, providing a short introduction to this more recently discovered group of non-coding RNAs.

The British Thoracic Society guidelines on the investigation and management of pulmonary nodules

The British Thoracic Society guideline for the investigation and management of pulmonary nodules is published as a supplement to this edition of the journal. It provides recommendations for the management of an individual with single or multiple pulmonary nodules and is a comprehensive reference text.

The Electronic Cigarette: The Good, the Bad, and the Ugly.

Electronic cigarettes (EC) are battery-powered nicotine delivery systems that have increased in popularity since they entered the US market.

EC has been reported to contain less carcinogens than traditional cigarettes, cause less acute lung effects in healthy individuals, and may help with smoking cessation. It has also been viewed as a potential safer alternative for asthmatic smokers, but its effects on lung functions are unclear.

However, EC do carry some harmful aspects as they contain formaldehyde and formaldehyde-forming hemiacetals as well as potentially toxic particulate matter that deposits on surfaces. EC are an increasingly popular device that could serve as a gateway into traditional cigarette smoking or illicit drugs. The popularity of EC has brought with it money from large tobacco corporations and mass marketing. Lack of regulation has generated product inconsistency and potential health hazards.

This review highlights what is known and what still needs to be answered about EC.

Pulmonary Rehabilitation for Patients with Chronic Airways Obstruction.

Pulmonary rehabilitation is a patient-centered and interdisciplinary intervention with major components of exercise training and self-management education. Although having no direct effect on lung function, this intervention often results in substantial improvements in respiratory symptoms, functional status, and health status. It probably also reduces subsequent health care utilization, especially when provided after a hospitalization for an exacerbation of airways disease.

The beneficial effects of pulmonary rehabilitation reflect its ability to reduce the impact of systemic consequences of chronic respiratory disease and to improve patients' self-efficacy through promoting collaborative self-management. Pulmonary rehabilitation is indicated for patients with respiratory diseases (regardless of specific diagnosis) who have persistent symptoms or functional or health status limitation despite otherwise optimal medical therapy.

Those patients with severe asthma (particularly those with airways remodeling) or asthma-chronic obstructive pulmonary disease overlap who have daily symptoms and substantial functional/health status limitation despite controller and bronchodilator therapy would be appropriate candidates for pulmonary rehabilitation.

Airway Obstruction Worsens in Young Adults with Asthma Who Become Obese.

Few studies have examined how developing obesity in early adulthood affects the course of asthma.

OBJECTIVE: We analyzed lung function and asthma impairment and risk among nonobese children with asthma, comparing those who were obese in young adulthood with those who remained nonobese.

METHODS: We carried out the post hoc analysis of 771 subjects with mild to moderate asthma who were not obese (pediatric definition, body mass index [BMI] < 95th percentile) when enrolled in the Childhood Asthma Management Program at ages 5-12 years. The subjects were then followed to age 20 years or more. For visits at ages 20 years or more, spirometry values as percent predicted and recent asthma symptom scores and prednisone exposure were compared between 579 subjects who were nonobese at all visits and 151 who were obese (adult definition of BMI ≥ 30 kg/m(2)) on at least 1 visit (median number of visits when obese = 4, IQR 2-7).

RESULTS: Compared with participants who were nonobese (BMI 23.4 ± 2.6 kg/m(2)), those who became obese (BMI 31.5 ± 3.8 kg/m(2)) had significant decreases in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P < .0003) and FEV1 (P = .001), without differences in FVC (P = .15) during visits at ages 20 years or more. For each unit increase of BMI, FEV1 percent predicted decreased by 0.29 (P = .0009). The relationship between BMI and lung function was not confounded by sex or BMI at baseline. Asthma impairment (symptom scores) and risk (prednisone use) did not differ between the 2 groups.

CONCLUSION: Becoming obese in early adulthood was associated with increased airway obstruction, without impact on asthma impairment or risk.

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