Clinics in chest medicine

Publisher: Elsevier


Impact factor 2.51

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  • Other titles
    Clinics in chest medicine (Online), Clinics in chest medicine
  • ISSN
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  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


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    • Author can archive a post-print version
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    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease is associated with chronic inflammation affecting predominantly lung parenchyma and peripheral airways and results in largely irreversible and progressive airflow limitation. This inflammation is characterized by increased numbers of alveolar macrophages, neutrophils, and T lymphocytes, which are recruited from the circulation. Oxidative stress plays a key role in driving this inflammation. The pulmonary inflammation may enhance the development and growth of lung cancer. The peripheral inflammation extends into the circulation, resulting in systemic inflammation with the same inflammatory proteins. Systemic inflammation may worsen comorbidities. Treatment of pulmonary inflammation may therefore have beneficial effects.
    Clinics in chest medicine 03/2014; 35(1):71-86.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although primarily a lung disease, chronic obstructive pulmonary disease (COPD) is now recognized to have extrapulmonary effects on distal organs, the so-called systemic effects and comorbidities of COPD. Skeletal muscle dysfunction, nutritional abnormalities including weight loss, cardiovascular complications, metabolic complications, and osteoporosis, among others, are all well-recognized associations in COPD. These extrapulmonary effects add to the burden of mortality and morbidity in COPD and therefore should be actively looked for, assessed, and treated.
    Clinics in chest medicine 03/2014; 35(1):101-130.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alpha1-antitrypsin (AAT) deficiency was first described in 1963 together with its associations with severe early-onset basal panacinar emphysema. The genetic defects leading to deficiency have been elucidated and the pathophysiologic processes, clinical variation in phenotype, and the role of genetic modifiers have been recognized. Strategies to increase plasma (and hence tissue) concentrations of AAT have been developed. The only recognized specific therapeutic strategy is regular infusions of the purified plasma protein, and evidence confirms its efficacy in protecting the lung (at least partially). Early detection and modification of lifestyle remains crucial to the management of AAT deficiency.
    Clinics in chest medicine 03/2014; 35(1):39-50.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bronchodilators are central in the symptomatic treatment of chronic obstructive pulmonary disease (COPD), although there is often limited reversibility of airflow obstruction. Three classes of bronchodilators (β2-agonists, antimuscarinic agents, methylxanthines) are currently available, which can be used individually, or in combination with each other or inhaled corticosteroids. Novel classes of bronchodilators have proved difficult to develop. The muscarinic β2-agonist molecules approach likely provides the best opportunity to develop combinations that combine corticosteroids with dual-bronchodilator activities, and thus potentially achieve better efficacy than is apparent with the current combination products that dominate the treatment of COPD.
    Clinics in chest medicine 03/2014; 35(1):191-201.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is currently defined as a common preventable and treatable disease that is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. The evolution of this definition and the diagnostic criteria currently in use are discussed. COPD is increasingly divided in subgroups or phenotypes based on specific features and association with prognosis or response to therapy, the most notable being the feature of frequent exacerbations.
    Clinics in chest medicine 03/2014; 35(1):1-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that cannot be described by the severity of airflow limitation (forced expiratory volume in the first second of expiration) only. Other measures are needed in clinical practice to assess patients, predict their risk, guide their treatment, and assess their response to it. Over the past few years, there has been a great deal of interest in the identification and validation of biomarkers of potential clinical use in COPD. Here, the authors review some general concepts in the field, discuss currently validated biomarkers in COPD, and speculate on potential future developments.
    Clinics in chest medicine 03/2014; 35(1):131-141.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The development of chronic obstructive pulmonary disease (COPD) is multifactorial, and the risk factors include both genetic and environmental factors. Although tobacco smoking is an established risk factor for COPD, many other associated factors remain underappreciated or neglected. Upto 50% of cases of COPD can be attributed to nonsmoking risk factors. This article describes the role of tobacco smoking and the various environmental risk factors associated with the development of COPD.
    Clinics in chest medicine 03/2014; 35(1):17-27.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Current international guidelines recommend that roflumilast be added on to an inhaled corticosteroid/long-acting β2-adrenoceptor agonist (LABA) combination therapy in high-risk patients with severe, bronchitic chronic obstructive pulmonary disease who have frequent acute exacerbations. This article presents evidence that a glucocorticoid, LABA, and phosphodiesterase (PDE) 4 inhibitor in combination can interact in a complex manner to induce a panel of genes that could act collectively to suppress inflammation and improve lung function. The possibility that multivalent ligands may deliver superior efficacy is also being explored. Single molecules that inhibit PDE4 and activate β2-adrenoceptors at similar concentrations have been described.
    Clinics in chest medicine 03/2014; 35(1):203-217.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical trials with new drugs for chronic obstructive pulmonary disease (COPD) have been performed. Viruses exacerbate COPD and bacteria may play a part in severe COPD; therefore, antibiotic and antiviral approaches have a sound rationale. Antiinflammatory approaches have been studied. Advances in understanding the molecular basis of other processes have resulted in novel drugs to target reactive oxidant species, mucus, proteases, fibrosis, cachexia, and muscle wasting, and accelerated aging. Studies with monoclonal antibodies have been disappointing, highlighting the tendency for infections and malignancies during treatment. Promising future directions are lung regeneration with retinoids and stem cells.
    Clinics in chest medicine 03/2014; 35(1):219-239.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The appropriate management of chronic obstructive pulmonary disease (COPD) involves more than taking prescription medicines. The key components have been set out in detail in many treatment guidelines, both national and international. They include the avoidance of identified risk factors, especially tobacco smoking, and the optimization of daily physical activity. This article reviews the key components of the pharmacologic treatment of COPD, both acute and chronic, with an emphasis on those recent studies, which are likely to change practice in the next few years.
    Clinics in chest medicine 03/2014; 35(1):177-189.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. The spectrum of physiologic derangements that exist in smokers with mild airway obstruction and a history compatible with COPD is examined. Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.
    Clinics in chest medicine 03/2014; 35(1):51-69.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Asthma and COPD are both heterogeneous lung diseases including many different phenotypes. The classical asthma and COPD phenotypes are easy to discern because they reflect extremes of a phenotypical spectrum. Thus asthma in childhood and COPD in smokers have their own phenotypic expression with underlying pathophysiological mechanisms that differ importantly. In older adults, asthma and COPD are more difficult to differentiate and there exists a bronchodilator response in most but not all patients with asthma and persistent airway obstruction in most but not all patients with COPD where even up to 50% have been reported to have some bronchodilator response as assessed with FEV1. Airway obstruction is generated in the large and small airways both in asthma and COPD, and this small airway obstruction is located more proximally in asthma, yet is found more distally in severe and older individuals with asthma, comparable to COPD. Though the underlying inflammation and remodelling processes in asthma and COPD are different in their extreme phenotypes, there are overlap phenotypes with eosinophilic inflammation even in stable COPD and neutrophilic inflammation in longstanding and severe asthma.
    Clinics in chest medicine 03/2014; 35(1):143-156.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic obstructive pulmonary disease (COPD) represents one of the main causes of morbidity and mortality worldwide. According to the World Health Organization, approximately 3 million people in the world die as a consequence of COPD every year. Tobacco use remains the main factor associated with development of disease in the industrialized world, but other risk factors are important and preventable causes of COPD, particularly in the developing world. The purpose of this review is to summarize the literature on the subject and to provide an update of the most recent advances in the field.
    Clinics in chest medicine 03/2014; 35(1):7-16.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Exacerbations are important events for patients with chronic obstructive pulmonary disease (COPD) and key outcomes in COPD studies and trials. Exacerbations have an impact on health status and contribute to disease progression, and exacerbation prevention is a key goal of therapy in COPD. A majority of COPD exacerbations are triggered by respiratory viral infections and/or bacterial infections. Several pharmacologic therapies can prevent COPD exacerbations and reduce hospital admissions. Nonpharmacologic interventions for exacerbation prevention include pulmonary rehabilitation, long-term oxygen therapy, and home noninvasive ventilator support. Improved management of acute exacerbations also prolongs the time to the next exacerbation event.
    Clinics in chest medicine 03/2014; 35(1):157-163.
  • Clinics in chest medicine 03/2014; 35(1):xiii.
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    ABSTRACT: This article represents a review of the current literature on the role of infection in the pathogenesis of chronic obstructive pulmonary disease (COPD), in stable disease, exacerbations, and pneumonia. It outlines the complex interactions between respiratory pathogens and host immune defenses that underlie the clinical manifestations of infection in COPD.
    Clinics in chest medicine 03/2014; 35(1):87-100.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Why only 20% of smokers develop clinically relevant chronic obstructive pulmonary disease (COPD) was a puzzle for many years. Now, epidemiologic studies point clearly toward a large heritable component. The combination of genome-wide association studies and candidate gene analysis is helping to identify those genetic variants responsible for an individual's susceptibility to developing COPD. In this review, the current data implicating specific loci and genes in the pathogenesis of COPD are examined.
    Clinics in chest medicine 03/2014; 35(1):29-38.
  • [Show abstract] [Hide abstract]
    ABSTRACT: As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is probably underused. Rapid progress is being made in nonsurgical approaches to lung volume reduction, but use outside specialized centers cannot be recommended presently. Noninvasive ventilation given to patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease reduces mortality and morbidity, but the place of chronic non-invasive ventilatory support remains more controversial.
    Clinics in chest medicine 03/2014; 35(1):251-269.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cigarette smoking is a major preventable cause of morbidity and mortality. It is the major risk factor for chronic obstructive pulmonary disease in the developed world. Smoking is a chronic relapsing disease. Optimal treatment includes nonpharmacologic support, together with pharmacotherapy. All clinicians should be comfortable with the use of nicotine replacement therapy, bupropion, and varenicline. Second-line therapies can be used by those familiar with their use. Effective use of these medications requires their integration into an effective management plan, which is likely to be a long-term undertaking, involving several cycles of remission and relapse.
    Clinics in chest medicine 03/2014; 35(1):165-176.