The bulk of this issue of Current Opinion in Pulmonary Medicine is devoted to various aspects of chronic obstructive pulmonary disease (COPD) with emphasis on new information. However, subjects of the first two articles were chosen not because of an abundance of new information but because they have yet to receive attention commensurate to their importance. The prevalence of smoking-related COPD in women in the US and other developed countries is increasing. In addition, millions of women in resource-poor countries develop COPD and other respiratory illnesses in large part due to indoor environmental exposures. Anita Varkey explores the risk factors that particularly affect women and offers suggestions for risk reduction. While there is a great deal of interest and work done on sleep-disordered breathing, sleep disorders in COPD and their consequences have been less well studied. Kesavan Kutty provides an up-to-date review of this subject.
Of all the medications available for the management of COPD, inhaled corticosteroids have justifiably elicited the most interest because of our increasing understanding of the inflammatory component of the disease. Kristin Highland in an evidence-based review clarifies the indications for use of inhaled corticosteroids in COPD.
Linus Santo Tomas and I discuss the importance of quality-of-life issues in patients with COPD. Clinicians will readily recognize that relief of dyspnea is of immediate and paramount importance to patients as it affects all aspects of their everyday life. Appropriately now clinicians and investigators are placing emphasis on quality-of-life measures in treating COPD and also incorporating them as outcome measures in clinical studies.
Lung-volume-reduction surgery (LVRS) over the years generated extreme hope and extreme despair. Neither of these extreme emotions is warranted based on the landmark 2003 report of the National Emphysema Treatment Trial. Terrence Trow analyzes the data and its conclusions. It is quite likely that the principle behind LVRS will be expanded in the future for less invasive approaches.
Andrew Chan and Roblee Allen review the topic of severe bronchiolitis obliterans both in the post-organ transplant and nontransplant settings. Although this topic was reviewed in recent years, since then there have been refinements in noninvasive diagnostic methods such as pulmonary function tests and high resolution computed tomography in posttransplant patients.
The last two articles focus on occupational asthma. Palomo Campo, Zana Lummus, and David Bernstein update the methods used in evaluation of occupational asthma. The table they provide on the pros and cons of each test should be of practical use for clinicians. Eduard Monsó examines the causes of occupational asthma and other respiratory illnesses in greenhouse workers.
I thank the authors for their contributions.