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Long-acting Beta-agonists in the Management of Chronic Obstructive Pulmonary Disease: Current and Future Agents

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and debilitating symptoms.

For patients with moderate-to-severe COPD, longacting bronchodilators are the mainstay of therapy; as symptoms progress, guidelines recommend combining bronchodilators from different classes to improve efficacy. Inhaled long-acting β2-agonists (LABAs) have been licensed for the treatment of COPD since the late 1990s and include formoterol and salmeterol. They improve lung function, symptoms of breathlessness and exercise limitation, health-related quality of life, and may reduce the rate of exacerbations, although not all patients achieve clinically meaningful improvements in symptoms or health related quality of life. In addition, LABAs have an acceptable safety profile, and are not associated with an increased risk of respiratory mortality, although adverse effects such as palpitations and tremor may limit the dose that can be tolerated...

Pulmonary Diseases and the Liver

Chronic liver disease is associated with many pulmonary complications.

Several, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax have been extensively reviewed. However, hepatobiliary manifestations of primary pulmonary diseases have received less attention. This review focuses on hepatobiliary complications of respiratory failure, cystic fibrosis, α-1 antitrypsin deficiency, sarcoidosis, and tuberculosis.

Smoking and the Outcome of Infection

Smoking has substantial local and systemic adverse effects on the immune system, respiratory tract and skin and soft tissues. Smokers are at increased risk of invasive pneumococcal disease, pneumonia, periodontitis, surgical infections, tuberculosis, influenza and meningococcal disease.

The results of several studies indicate that smokers with periodontitis or tuberculosis suffer more‐severe disease. Data on the impact of smoking in sepsis and pneumonia are controversial and limited, and systematic data regarding the outcome of the majority of infections in smokers are scarce. Abundant data indicate that children exposed to environmental tobacco smoke (ETS) suffer from more‐severe infections.

However, information regarding the effects of ETS on the outcome of infections in adul...

The Year of the Lung: Outdoor air pollution and lung health.

With reference to the Year of the Lung, current knowledge of the respiratory effects of current ambient air pollution is reviewed. Acute respiratory effects are well established.

Studies such as SAPALDIA and others now shed light on the long-term effects on chronic pathologies and on the health benefit of air quality improvements. The identification of those at highest risk and of local effects of not yet regulated traffic-related pollutants remains a research priority.

Effect of Obesity on Asthma Phenotype is Dependent upon Asthma Severity.

We recently reported that obese and non-obese patients with asthma have similar airflow limitation and bronchodilator responsiveness, but obese patients have more symptoms overall. There is limited information on the effect of obesity on asthmatics of varying severity measured by objective physiological parameters.

Understanding how obesity affects asthmatics of differing severity can provide insights into the pathogenesis of asthma in the obese and a rationale for the therapeutic approach to such patients.

Methods. Participants with asthma from two American Lung Association-Asthma Clinical Research Center (ALA-ACRC) studies were grouped by tertiles of airflow obstruction (forced expiratory volume in one second (FEV(1)%) predicted, FEV(1)/forced vital capacity (FVC)) and methacholine reactivity (PC(20)FEV(1)). Within each tertile, we examined the independent effect of body mass index (BMI), divided into normal weight, overweight, and obese categories, on lung function, airway reactivity, and symptoms.

Results. Overall, both FEV(1) and FVC decreased and symptoms worsened with increasing BMI; airway reactivity was unchanged. When stratified by the degree of airflow obstruction, higher BMI was not associated with greater airway reactivity to methacholine. Higher BMI was associated with more asthma symptoms only in the least obstructed FEV(1)/FVC tertile. When stratified by degree of airway reactivity, BMI was inversely associated with FVC in all PC(20)FEV(1) tertiles. BMI was directly associated with asthma symptoms only in those with the least airway reactivity.

Conclusions. Obesity does not influence airway reactivity in patients with asthma and it is associated with more symptoms only in those with less severe disease.

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