The clinical respiratory journal
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Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality and is characterised by persistent airway inflammation, which leads to impaired airway function, quality of life and intermittent exacerbations. In spite of recent advances in the treatment of COPD, new treatment options for COPD are clearly necessary. The oral phosphodiesterase-4 (PDE4) inhibitor roflumilast represents a new class of drugs that has shown efficacy and acceptable tolerability in preclinical and short-term clinical studies in patients with COPD. ⋯ Roflumilast is beneficial for maintenance treatment of patients with severe and symptomatic COPD and with a history of frequent acute exacerbations as an add-on to treatment with long-acting bronchodilators. It may have a role as an alternative to inhaled corticosteroids in more symptomatic COPD patients with frequent exacerbations, although direct comparisons are currently lacking.
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Cold-related respiratory symptoms are common among northern populations, especially among people suffering from respiratory diseases. However, the prevalence of such symptoms in the general population and the threshold temperatures at which the symptoms start to emerge are poorly known. ⋯ Cold-related respiratory symptoms are common in patients with chronic respiratory diseases, but they start to emerge at relatively low temperatures. In a cold climate, the cold-related symptoms may have an impact on the health-related quality of life.
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Asthma and chronic obstructive pulmonary disease (COPD) are both inflammatory disorders. Diagnosis of these diseases is based upon limitation of expiratory airflow. The pathophysiological correlates to this impaired lung function are complex but they are associated with the development of structural changes in the airways and lung parenchyma. These remodeling processes differ between the two diseases. In asthma, airways obstruction is predominately located in the large airways, although recent studies indicate that inflammation and structural changes also is present in other compartments of the lungs. In COPD, remodeling of the small airways and lung parenchyma are the main correlates to the limitation of expiratory airflow. However, both asthma and COPD are heterogeneous disorders including various phenotypes and there is a considerable overlap between the two diseases. ⋯ In COPD and severe asthma, current anti-inflammatory pharmacotherapy does not restore lung function impairment fully. It is therefore recognized that research aiming to explore mechanisms of airway remodeling should be encouraged.
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To determine the prevalence and predictors of undiagnosed chronic obstructive pulmonary disease (COPD) in Norway. ⋯ Two out of three COPD patients in Norway are undiagnosed. Risk factors for being undiagnosed are moderate reduction in lung function, absence of COPD symptoms and self-report of being in good health.
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The pattern of granulocyte infiltration can be used to identify different inflammatory phenotypes in asthma. Recognized granulocyte phenotypes using induced sputum are eosinophilic (EA), neutrophilic, mixed granulocytic and paucigranulocytic asthma. ⋯ Clinically useful applications of induced sputum analysis are the detection of non-adherence to corticosteroid therapy, assessment of adequacy of inhaled corticosteroid therapy, long-term therapy management in asthma, oral corticosteroid dose adjustment in refractory asthma and assessment of occupational asthma.