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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was formed in the late 1990s to spread awareness of chronic obstructive pulmonary disease (COPD) as a major public health problem and facilitate its prevention and treatment. GOLD has since become internationally recognized for the development of evidence-based strategy documents, most notably the annual GOLD Reports, for COPD diagnosis, management, and prevention. The GOLD Reports incorporate the latest evidence and expert consensus to guide the management and prevention of COPD on a global level. Since the first GOLD Report in 2001, profound innovations have taken place regarding inhaler device options, available pharmaceuticals, knowledge regarding effective dosages and potential side effects, and the various combinations of drugs used to relieve symptoms. Concomitantly, an evolution of expert opinion on how best to apply these innovations to the care of patients with COPD has also taken place, an evolution that is nowhere more detailed or definitive than in the 20 years of annual GOLD Reports. We summarize key features and trends in inhalation therapy for stable COPD in these Reports.

Background: Because of high smoking rates and HIV-related factors, people with HIV may be at high risk for chronic obstructive pulmonary disease (COPD); however, population-based estimates of the incidence of COPD among people with HIV are lacking, particularly for women. We compared the incidence of COPD among Ontario adults aged 35 years or more with and without HIV between Jan. 1, 1996, and Dec. 31, 2015., Methods: We conducted a population-based study using Ontario's health administrative databases. We compared the incidence of COPD between people with and without HIV using standardized incidence ratios and generalized estimating equations with a log link function., Results: We identified 1849 people with HIV and 1 168 727 HIV-negative people who were newly diagnosed with COPD between 1996 and 2015. People with HIV were younger than HIV-negative people (mean age 49.7 [standard deviation 10.4] yr v. 62.2 [standard deviation 14.8] yr; standardized difference 0.98). Rates of COPD were higher among people with HIV than among HIV-negative people (10.4 v. 9.0 cases per 1000 person-years; standardized incidence ratio 1.16, 95% confidence interval [CI] 1.10 to 1.21; adjusted rate ratio 1.34, 95% CI 1.27 to 1.41). In sex-stratified analyses, rates of COPD were higher among men with HIV (adjusted rate ratio 1.32, 95% CI 1.24 to 1.40) and women with HIV (adjusted rate ratio 1.54, 95% CI 1.37 to 1.72) than among men and women without HIV. In a sensitivity analysis, smoking explained observed differences in COPD incidence., Interpretation: People with HIV had higher rates of incident COPD than HIV-negative people. This may reflect the disproportionately higher prevalence of smoking among the former., Competing Interests: Competing interests: None declared., (Copyright 2020, Joule Inc. or its licensors.)

This article presents a partial bioarchaeology of care case study of a mummified adult female with chronic obstructive pulmonary disease (COPD) from late historic period United States. It examines likely clinical and functional impacts of disease and corresponding need for provision of care, stopping short of Stage 4 Interpretation/analysis. The case study illustrates and argues for the importance of an interdisciplinary research team for achieving a comprehensive understanding of disability and care. The article highlights the necessity of knowledge of pathophysiology for identifying the potential interventions (supports) dictated by the associated functional limitations. inter alia, this case is a powerful illustration of the way analysis of preserved soft tissue can provide insights into disease and likely care that are inaccessible using skeletal analysis alone. The article represents an interesting contribution to the theory and methodology of both the bioarchaeology of care approach and mummy studies., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The mushroom Amanita muscaria (fly agaric) is widely distributed throughout continental Europe and the UK. Its common name suggests that it had been used to kill flies, until superseded by arsenic. The bioactive compounds occurring in the mushroom remained a mystery for long periods of time, but eventually four hallucinogens were isolated from the fungus: muscarine, muscimol, muscazone and ibotenic acid. The shamans of Eastern Siberia used the mushroom as an inebriant and a hallucinogen. In 1912, Henry Dale suggested that muscarine (or a closely related substance) was the transmitter at the parasympathetic nerve endings, where it would produce lacrimation, salivation, sweating, bronchoconstriction and increased intestinal motility. He and Otto Loewi eventually isolated the transmitter and showed that it was not muscarine but acetylcholine. The receptor is now known variously as cholinergic or muscarinic. From this basic knowledge, drugs such as pilocarpine (cholinergic) and ipratropium (anticholinergic) have been shown to be of value in glaucoma and diseases of the lungs, respectively.

COPD has become a more popular research area in the last 3 decades, yet the first clear descriptions of acute and chronic bronchitis were in 1808. This brief history, comprehensively referenced, leads us through the early developments in respiratory physiology and their applications. It emphasises the early history of chronic bronchitis and emphysema in the 19(th) and early 20(th) centuries, long before the dominant effects of cigarette smoking emerged. This remains relevant to developing countries today.

Background: Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort., Methods: We used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors., Results: Compared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups., Conclusions: We found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups.

In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients' functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD.

Pulmonary rehabilitation is a complex intervention for which it is difficult to craft a succinct yet inclusive definition. Pulmonary rehabilitation should be considered for all patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or have decreased functional status despite otherwise optimal medical management. The essential components of pulmonary rehabilitation are exercise training and self-management education, tailored to the needs of the individual patient and integrated into the course of the disease trajectory. Emerging data support a role for pulmonary rehabilitation in nontraditional contexts, such as during exacerbation in the non-COPD patient and in the home setting., (Published by Elsevier Inc.)

The history of oxygen from discovery to clinical application for patients with chronic lung disease represents a long and storied journey. Within a relatively short period, early investigators not only discovered oxygen but also recognized its importance to life and its role in respiration. The application of oxygen to chronic lung disease, however, took several centuries. In the modern era, physiologists pursued the chemical nature of oxygen and its physiologic interaction with cellular metabolism and gas transport. It took brazen clinicians, however, to pursue oxygen as a therapeutic resource for patients with chronic lung disease because of the concern in the 20th century of the risks of oxygen toxicity. Application of ambulatory oxygen devices allowed landmark investigations of the long-term effects of continuous oxygen that established its safety and efficacy. Although now well established for hypoxic patients, many questions remain regarding the benefits of oxygen for varying severity and types of chronic lung disease.

Introduction: There is growing interest in preventable, non-smoking causes of chronic obstructive pulmonary disease (COPD), among which are chronic exposures to respiratory irritants in the workplace., Sources of Data: Reviews of occupational COPD in specific occupations and industries and in general populations; supplemented with other or more recently published material., Areas of Agreement: There is good evidence for an increased risk of COPD from certain specific exposures (coal mine dust, silica, welding fume, textile dust, agricultural dust, cadmium fume)., Areas of Controversy: Less clear is the causal role of non-specific dusts or fumes/gases in general populations where the available literature is notably uncritical., Growing Points: Other specific exposures, such as diesel fume; interactions between specific exposures and cigarette smoking; the development of safe working limits., Areas Timely for Developing Research: Occupations with large numbers of exposed employees, particularly in low-income countries.

The clinical concept of COPD initially started in conjunction with American Emphysema and British Bronchitis in CIBA Guest Symposium in 1958. JC Hogg, et al. recognized the peripheral airways as the major site of airflow obstruction in COPD in 1968. Thirty-six years later in 2004, JC Hogg, et al. described the pathological nature of small-airway obstruction in COPD. The GOLD project provided state-of-the-art information about COPD in 2001, in which it is stated that the chronic airflow limitation characteristic of COPD is caused by a mixture of small airway disease and parenchymal destruction. Cigarette smoke may accelerate the aging of lung or worsen aging-related events in lung by defective resolution of inflammation. Accelerated decline in lung function is recognized to occur in asthma, especially in those with asthma who smoke. With increasing age, there was a greater increase in the proportion of patients with overlapping COPD and asthma.

Sleep-related breathing disorders are common adult illnesses in Western countries and classified as either dominant obstructive sleep apnoea or dominant central sleep apnoea. Cheyne-Stokes Respiration is part of the spectrum of CSA. The earliest descriptions of patients who presumably suffered from sleep apnoea were made in the 19th century. The term ''Pickwickian'' in connection with sleepy patients was introduced in 1889. The first electrophysiological sleep recordings of Pickwickian patients and the understanding of the syndrome as disordered breathing in sleep, were made during the late 1950s and 1960s at the universities of Heidelberg and Freiburg in Germany. The term sleep apnoea syndrome was introduced by Guilleminault from Stanford. The introduction of continuous positive airway pressure (CPAP) therapy by C. E. Sullivan and co-workers gave an enormous impetus to the field of sleep-disordered breathing. Its recognition as a public health problem was facilitated by the Wisconsin study, investigating the prevalence of sleep apnoea in the middle-aged general population. Nowadays obstructive sleep apnoea (OSA) is recognised as an independent risk factor for a wide range of clinical conditions, such as atherosclerosis, hypertension, heart failure, arrhythmias, stroke, diabetes, and depression. This article focuses on issues related to OSA and CSA/CSR, their pathogenesis, interaction with other comorbidities including cardiovascular diseases. Future research will focus on treatment effects on cardiovascular and metabolic outcomes in sleep apnoea and on the pathophysiological mechanisms responsible for the inflammatory state and cardiovascular morbidity in the syndrome. Other potential areas of research include biochemical markers, new diagnostic and therapeutic modalities., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

The term COPD which comprises chronic obstructive bronchitis and emphysema, was first defined in 1964. Key milestones to the understanding of the etiopathology of COPD were the discovery of the association between tobacco consumption and the development of chronic bronchitis as well as the discovery of the role of a protease-antiprotease imbalance leading to emphysema. The assessment of functional impairement of patients with COPD was established in the 1960s and the quantification and localisation was predominantly explored in the 1980s. The management of COPD comprises preventative measures (e.g. smoking cessation, vaccination against influenza, reduction of occupation hazards), medical therapies (bronchodilators, corticosteroids), non-pharmacological therapies (exercise training, patient education, physiotherapy) as well as surgical options. The prevention and efficiency management of exacerbations are of particular importance. Optimal management of COPD has to take impact of the disease on other organs into account. The future of COPD-related research lies in the development of international and national networks to facilitate the analysis of genetic factors on the pathology of COPD., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

Pulmonary rehabilitation is a standard of care for patients with chronic lung disease. Through appropriate patient selection and assessment, exercise training, educational and psychosocial intervention, nutritional counseling, and breathing retraining, many benefits (e.g., reduction in level of dyspnea, improvement in exercise tolerance, improvement in health-related quality of life, and reduction in health care resource utilization) are gained by patients who have undergone rehabilitation. From the initial finding of improved patient's capabilities, to times of extreme skepticism and doubt, to the state of being a standard of care, pulmonary rehabilitation has undergone many periods of transformation over the last several decades. This review expands upon previous reviews of the history behind modern-day pulmonary rehabilitation.

Chronic obstructive pulmonary disease (COPD) is the currently favoured name for the diseases formerly known as emphysema and bronchitis. COPD has been recognized for more than 200 years. Its cardinal symptoms are cough, phlegm and dyspnea, and its pathology is characterized by enlarged airspaces and obstructed airways. In the 19th century, the diagnosis of COPD depended on its symptoms and signs of a hyperinflated chest, and reduced expiratory breath sounds. The airflow obstruction evident on spirometry was identified in that century, but did not enter into clinical practice. Bronchitis, and the mechanical forces required to overcome its obstruction, was believed to be responsible for emphysema, although the inflammation present was recognized. The causes of bronchitis, and hence emphysema, included atmospheric and domestic air pollution, as well as dusty occupations. Cigarette smoking only became recognized as the dominant cause in the 20th century. The lessons learned of the risks for COPD in 19th-century Britain are very pertinent to the world today.

Pulmonary rehabilitation is widely accepted as effective therapy for patients with chronic obstructive pulmonary disease (COPD). This paper presents a brief (and somewhat subjective) history of pulmonary rehabilitation, and stresses the development of the exercise component. Until the middle of the 20th century, patients with COPD were advised to avoid the dyspnea that activity brings. Barach can be credited with positing that patients with COPD should strive to be more active. In the 1960s Petty created the multi-disciplinary team that was found to be effective in delivering pulmonary rehabilitation. In the 1980s doubts surfaced as to the ability of rehabilitative exercise to improve muscle function in COPD, but in the 1990s studies showed that well-designed exercise programs caused beneficial physiologic adaptations. The current decade has yielded studies that exploited those insights to design interventions that boost the effectiveness of rehabilitative exercise.

Chronic obstructive pulmonary disease (COPD) is an increasing health problem and one of the leading causes of morbidity and mortality worldwide, but knowledge about its pathogenesis has increased substantially in recent years. The disease results from interaction between individual risk factors (like enzymatic deficiencies) and environmental exposures to noxious agents, like cigarette smoking, occupational dusts, air pollution and infections in childhood. The main mechanisms that may contribute to airflow limitation in COPD are fixed narrowing of small airways, emphysema and luminal obstruction with mucus secretions. COPD is characterised by a chronic inflammatory process in the pulmonary tissue, with a pattern different from bronchial asthma, associated with extrapulmonary effects and is considered now a complex, systemic disease. Optimal therapeutic targeting of COPD depends on a clear understanding of the precise mechanisms of these complex processes and on early and correct evaluation of disease severity. A combination of pharmacological and non-pharmacological approaches is used to treat COPD. Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnoea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, non-invasive mechanical ventilation offers new alternatives for patients with acute or chronic failure.

A brief review of changes in the concept of COPD was made based on records of mile stone articles and prestigious international lung conferences. A major innovation in the definition of COPD was presented by the 'GOLD WORKSHOP REPORT' published in 2001. It introduced a concept of inflammatory response of the lung to toxic gas/particles as the most significant pathogenesis of the disease, eliminating the definition of COPD being a syndrome of 'emphysema plus chronic bronchitis'. Both CIBA Guest Symposium and Aspen Emphysema Conference contributed in the evolution of COPD concept. Also discussed in brief are the impacts of 'Small Airway Disease Theory' and British bronchitis hypothesis. The GOLD revision 2006 may be highly appreciated among practicing clinicians world wide with key features; 'COPD is preventable and treatable accompanied by significant systemic effects'.

Surgical procedures designed to improve pulmonary function and quality of life of patients with advanced emphysema have been attempted for more than a century. Of the many attempted procedures, only giant bullectomy, lung transplantation, and lung-volume-reduction surgery have withstood the test of time and are currently being practiced. This article reviews each of these procedures and also develops a rational approach to selecting appropriate candidates for these 3 interventions.

The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years. The stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose. Knowledge of the pathogenesis, course and prognosis, and new approaches to therapy have dramatically improved our understanding of this important clinical entity. Smoking cessation improves the early course of disease. Long-term oxygen improves the length and quality of life in selected patients with hypoxemia. Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.

COPD is a name proposed by two American doctors, M.H. Williams and N.S. Seriff, to describe a disease entity combining chronic bronchitis and pulmonary emphysema, manifested in patients as an obstructive ventilatory disorder with a main symptom of chronic dyspnea. Since the 1970s, COPD has been considered a smokers' disease brought on chiefly by the chronic stimulation of tobacco smoke. In 2001, the GOLD guideline indicated that COPD should not refer to a disease combining chronic bronchitis and pulmonary emphysema, but rather to a disease state characterized by an airflow limitation that is not fully reversible. Nonetheless, problems still remain in defining this disease entity.

The so-called 'Dutch hypothesis' (Fletcher) which describes chronic obstructive (restrictive) pulmonary disease (CO(R)PD) as a consequence of complicated childhood asthma (from 1900-1960) is well-founded. It can explain many aspects of the ever changing pattern of asthma and COPD in the Western world. Severe respiratory disease in children during the first part of the 20th century was primarily the result of respiratory complications of measles and whooping cough, and caused a high mortality in children below the age of two years. Gradually more children survived and a picture of the complications was formed: chronic bronchitis and bronchiectasis. In 1939 it was suggested that this happened mainly in children with asthmatic predisposition and this pattern was documented in detail in the post World War II period. After 1970 the complications virtually disappeared as a result of vaccination and improved therapy. Consequently, bronchiectasis and cor pulmonale became rare and CO(R)PD became COPD, the old-age form of asthma. There has also been a marked increase in asthma after childhood over the past 30 years. The double role of obstruction-provoking and anti-obstructive (and asthma-masking) infections plays an important role in this respect. The old picture from the fifties in the Western world still prevails in developing countries. Prevention of this 'old COPD' must consist of vaccination against measles and whooping cough (and possibly also against respiratory syncytial virus), and treatment of asthma.

In the last 200 years or so, the recognition, diagnosis, and understanding of the pathogenesis of COPD have evolved considerably. Over the past few decades, various definitions of COPD and its "components" also have developed. Despite this, however, the treatment options for patients with this relentlessly progressive disorder are relatively limited. In the mid-19th century, the introduction of the spirometer yielded a powerful tool for the diagnosis of COPD. The currently available small, cheap spirometers hold great promise to help patients and their physicians closely monitor lung function. Early recognition of the close associations among emphysema and, more recently, small airways disease, and impaired airflow is discussed. This review also stresses the importance of the identification of COPD in its initial stages and the early onset of appropriate treatment. The therapy for COPD has changed in the last 40 years. Drug therapies in the 1960s included potassium iodide and ephedrine. Corticosteroids were not used, and oxygen therapy and exercise were actually contraindicated. Modern therapy for COPD is now more systematic and includes the use of bronchodilators and corticosteroids to improve airflow, in addition to oxygen therapy, pulmonary rehabilitation and, in selected patients, lung volume reduction surgery. The causal link between the chronic inhalation of tobacco smoke and COPD is beyond doubt, and smoking cessation remains the most important goal for patients. It is hoped that new, more effective therapies will soon be available for the treatment of this disabling disorder to provide improvement in symptoms and patient quality of life and to reduce or stop the rate of disease progression and mortality in patients with COPD.