Common Chronic Respiratory Diseases Research Articles

Asthma and COPD proteomics: current approaches and future directions.

Although asthma and chronic obstructive pulmonary disease COPD represent the two most common chronic respiratory diseases worldwide, the mechanisms underlying their pathobiology need to be further elucidated. Presently, differentiation of asthma and COPD are largely based on clinical and lung function parameters. However, the complexity of these multifactorial diseases may lead to misclassification and to inappropriate management strategies. Recently, tremendous progress in MS has extended the sensitivity, accuracy, and speed of analysis, enabling the identification of thousands of proteins per experiment. Beyond identification, MS has also greatly implemented quantitation issues allowing to assess qualitative-quantitative differences in protein profiles of different samples, in particular diseased versus normal. Herein, we provide a summary of recent proteomics-based investigations in the field of asthma/COPD, highlighting major issues related to sampling and processing procedures for proteomic analyses of specific airway and parenchymal specimens (induced sputum, exhaled breath condensate, epithelial lining fluid, bronchoalveolar and nasal lavage fluid), as well as blood-derived specimen (plasma and serum). Within such a context, together with current difficulties and limitations mainly due to lack of general standardization in preanalytical sampling procedure, our discussion will focus on the challenges and possible benefits of proteomic studies in phenotypic stratification of asthma and COPD.

Clinical, economic, and humanistic burden of asthma in Canada: a systematic review.

BackgroundAsthma, one of the most common chronic respiratory diseases, affects about 3 million Canadians. The objective of this study is to provide a comprehensive evaluation of the published literature that reports on the clinical, economic, and humanistic burden of asthma in Canada.MethodsA search of the PubMed, EMBASE, and EMCare databases was conducted to identify original research published between 2000 and 2011 on the burden of asthma in Canada. Controlled vocabulary with “asthma” as the main search concept was used. Searches were limited to articles written in English, involving human subjects and restricted to Canada. Articles were selected for inclusion based on predefined criteria like appropriate study design, disease state, and outcome measures. Key data elements, including year and type of research, number of study subjects, characteristics of study population, outcomes evaluated, results, and overall conclusions of the study, were abstracted and tabulated.ResultsThirty-three of the 570 articles identified by the clinical and economic burden literature searches and 14 of the 309 articles identified by the humanistic burden literature searches met the requirements for inclusion in this review. The included studies highlighted the significant clinical burden of asthma and show high rates of healthcare resource utilization among asthma patients (hospitalizations, ED, physician visits, and prescription medication use). The economic burden is also high, with direct costs ranging from an average annual cost of $366 to $647 per patient and a total annual population-level cost ranging from ~ $46 million in British Columbia to ~ $141 million in Ontario. Indirect costs due to time loss from work, productivity loss, and functional impairment increase the overall burden. Although there is limited research on the humanistic burden of asthma, studies show a high (31%-50%) prevalence of psychological distress and diminished QoL among asthma patients relative to subjects without asthma.ConclusionsAs new therapies for asthma become available, economic evaluations and assessment of clinical and humanistic burden will become increasingly important. This report provides a comprehensive resource for health technology assessment that will assist decision making on asthma treatment selection and management guidelines in Canada.

Chinese guideline for the prevention and management of bronchial asthma (Primary Health Care Version).

Bronchial asthma (hereinafter referred to as asthma in this text) is one of common chronic respiratory diseases, and its global prevalence has been on the rise over the recent years. Clinical studies and practices show that standardized diagnosis and treatment, plus practically effective management, are important to achieve better asthma control and quality of life. The Asthma Workgroup, CMA Society of Respiratory Diseases, revised the Chinese Guidelines for Prevention and Treatment of Bronchial Asthma (hereinafter referred to as the Guidelines) twice, in 2003 and 2008.

Association of ADAM33 gene polymorphisms with asthma in the Uygur population of China

Asthma is one of the most common chronic respiratory diseases, affecting ∼300 million children and adults worldwide. Previous studies identified a disintegrin and metalloprotease domain 33 (ADAM33) as an important susceptibility gene for asthma in patients of different nationalities; however, it is unknown whether this relationship exists in ethnically diverse populations. The present study focused on the association between single-nucleotide polymorphisms (SNPs) of the ADAM33 gene and asthma in the Uygur population of China. Three SNPs of ADAM33 (T1, S+1 and F+1) were genotyped in a case-control study among the Chinese Uygur population, involving 126 adult asthmatic patients and 126 healthy controls. The frequency of the ADAM33 T1 C allele among asthma patients was significantly higher compared to healthy controls (20.6 vs. 11.1%, P=0.003). The distribution of ADAM33 genotypes differed significantly between the two groups. The frequency of the T1 TC genotype was higher among patients compared to healthy controls [odds ratio (OR)=2.118, P=0.016] and the variant genotype, TC+CC, increased the risk of asthma (OR=2.244, P=0.005). Following adjustment for confounding factors, the ORs of TC and TC+CC for asthma were 2.317 and 2.522, respectively. There was a significant decrease in the forced expiratory volume (FEV1) levels in patients with the TC genotype compared to the TT genotype of T1. Haplotype analysis revealed that the frequencies of Hap5 (CAC) and Hap6 (CAT) were significantly higher among asthmatic patients compared to healthy controls (P=0.024 and 0.016, respectively). The genotype and allele frequencies of SNP S+1 and F+1 were not statistically different between asthmatic patients and controls. In conclusion, the ADAM33 T1 SNP may affect susceptibility to asthma in the Chinese Uygur population.

Educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases: A systematic review protocol

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

Prevalence of common chronic respiratory diseases in drug misusers: a cohort study

A randomised controlled trial of substance misuse indicated that many patients who use methadone have respiratory symptoms and/or are prescribed respiratory medications. There is little research in this area. To determine the prevalence of respiratory disease and prescriptions among drug misusers. This historical cohort study of drug misusers and matched controls analysed routinely collected primary care data. The prevalence of common chronic respiratory diseases, class and number of respiratory medications were examined. The cohort of 18,570 patients (9,285 per group) was mostly male (64%, n=11,890) and aged 31-59 years (76%, n=14,060). After adjusting for age, gender, deprivation and smoking status, the results showed that more drug misusers than controls had a diagnosis of asthma or chronic obstructive pulmonary disease (17.1% vs. 10.9%; adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.46 to 1.77, and 2.4% vs. 0.8%; OR 1.86, 95% CI 1.42 to 2.44, respectively) and were prescribed more chronic respiratory medications: short-acting β(2)-agonists (16.4% vs. 7.9%; OR 2.00, 95% CI 1.80 to 2.22), long-acting β(2)-agonists (1% vs. 0.4%; OR 1.93, 95% CI 1.29 to 2.89), and inhaled corticosteroids (10.6% vs. 7.6%; OR 1.49, 95% CI 1.33 to 1.67). All differences were statistically significant (p<0.001). Drug misusers have a significantly higher prevalence of respiratory diseases and respiratory prescriptions than matched controls. Further work is needed to determine the reasons for this.

Abnormal Lung Aging in Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis

Aging is a natural process characterized by progressive functional impairment and reduced capacity to respond appropriately to environmental stimuli and injury. The incidence of two common chronic respiratory diseases (chronic obstructive pulmonary disease [COPD] and idiopathic pulmonary fibrosis [IPF]) increases with advanced age. It is plausible, therefore, that abnormal regulation of the mechanisms of normal aging may contribute to the pathobiology of both COPD and IPF. This review discusses the available evidence supporting a number of aging mechanisms, including oxidative stress, telomere length regulation, cellular and immunosenescence, as well as changes in a number of antiaging molecules and the extracellular matrix, which are abnormal in COPD and/or IPF. A better understanding of these abnormalities may help in the design of novel and better therapeutic interventions for these patients.

ASSOCIATION BETWEEN AIR POLLUTION AND MONTHLY RESPIRATORY PRESCRIBING IN PRIMARY HEALTH CARE

Background and Aims: Asthma and Chronic Obstructive Pulmonary Disease (COPD) are two of the most common chronic respiratory diseases. The effect size of exacerbation of respiratory symptoms triggered by daily variation of air pollution has been found to be between 1% (Atkinson 2001; Medina-Ramon 2006) and 7% (Laurent 2009) per 10μg/m3. We aimed to assess the relationship between routinely collected respiratory prescribing and air quality at primary health care level using a multilevel statistical model including consideration of lags. Due to universal health care coverage in the UK this is a polulation based analysis. Methods: We analysed respiratory medication (salbutamol) prescribed monthly by 64 primary care practices (400,000+ population) in the Northeast of England, (2002-2006) in two stages. Firstly, we used a harmonic dynamic regression model to reflect area-wide monthly average respiratory prescribing rates in relation to monthly temperature. Using the monthly prescribing rate as offset we then built the multilevel model using air quality, deprivation and demographic covariates by primary health care practice, using monthly respiratory prescribing rate as offset. Results: Our final model showed that an increase of 10μg/m3 in ambient PM10 was associated with an increase of 1% (95% CI, 0.1-2%) in monthly salbutamol prescribing. We demonstrated that monthly respiratory prescribing in primary care can be used as indicator of air pollution effect on asthma and COPD, increasing the scope of its use for health surveillance. Conclusions: The magnitude of effect found in this study was in the order that could be expected from studies of daily level associations between air pollution and asthma outcomes. The use of a multilevel model with offset provided a realistic representation of the relationship, as it allowed to both handle the grouped nature of primary care data and account for the seasonal variation of respiratory health outcomes.

P1-276 A historical cohort study to determine the prevalence of common chronic respiratory diseases and medication use in drug misusers

IntroductionA local substance misuse study and anecdotal evidence from primary care suggested many methadone patients have respiratory disease and/or respiratory prescriptions.MethodThis exploratory study used a historical cohort design with matched...

Book Review: Asthma: A Clinician's Guide. Margaret Varnell Clark MS RN RRT-NPS. Sudbury, Massachusetts: Jones &amp; Bartlett. 2011. Soft cover, 174 pages, $39.95.

Asthma is one of the most common chronic respiratory diseases of both adults and children, and yet it is difficult to summarize the diagnosis and care of this disorder. Despite extensive research we still do not clearly understand its pathophysiology or genetics. Due to its high prevalence, all

S108 A historical cohort study to determine the prevalence of common chronic respiratory diseases and medication use in drug misusers

Introduction and aimA local substance misuse study and anecdotal evidence from primary care, suggested many methadone patients have respiratory disease and/or prescriptions for respiratory preparations. Anecdotal evidence from clinical colleagues...

High Prevalence of Bronchiectasis in Adults: Analysis of CT Findings in a Health Screening Program

Bronchiectasis is one of the common chronic respiratory diseases and associated with respiratory morbidity and mortality. However, neither its prevalence nor its etiology is well-defined. We aimed to estimate the prevalence and risk factors of bronchiectasis in adults. In a retrospective study, we analyzed radiologic findings on chest computed tomography (CT) images performed as part of a health-screening program. From January to December 2008, 1,409 (24.6%) of 5,727 participants in the screening program of a health promotion center at a university hospital underwent chest CT scans based on the subject's decision. Bronchiectasis was diagnosed, if there was abnormal bronchial dilatation in any area of both lungs on chest CT. Respiratory symptoms, smoking status, and past medical history were also analyzed to define clinical characteristics and risk factors of bronchiectasis. Of 1,409 patients (aged 23-86 years), who were screened for respiratory diseases using chest CT for one year in a health promotion center, 129 patients (9.1%) were diagnosed with bronchiectasis. The prevalence of bronchiectasis was higher in females than in males (11.5% vs. 7.9%, p = 0.022) and increased with age. Respiratory symptoms were reported in 53.7% of subjects. Previous history of tuberculosis (TB) (OR 4.61, 95% CI 2.39-8.88, p = 0.001) and age (OR 2.49, 95% CI 1.56-3.98, p = 0.001) were significantly associated with bronchiectasis. This retrospective analysis of chest CT findings in health screening examinees revealed a very high prevalence of bronchiectasis in adults. Previous TB infection is one of the major causes of bronchiectasis.

Impact of Cough Across Different Chronic Respiratory Diseases: Comparison of Two Cough-Specific Health-Related Quality of Life Questionnaires

Cough is a prominent symptom across a range of common chronic respiratory diseases and impacts considerably on patient health status. We undertook a cross-sectional comparison of scores from two cough-specific health-related quality of life (HRQoL) questionnaires, the Leicester Cough Questionnaire (LCQ), and the Cough Quality of Life Questionnaire (CQLQ), together with a generic HRQoL measure, the EuroQol. Questionnaires were administered to and spirometry performed on 147 outpatients with chronic cough (n = 83), COPD (n = 18), asthma (n = 20), and bronchiectasis (n = 26). There was no significant difference in the LCQ and CQLQ total scores between groups (p = 0.24 and p = 0.26, respectively). Exploratory analyses of questionnaire subdomains revealed differences in psychosocial issues and functional impairment between the four groups (p = 0.01 and p = 0.05, respectively). CQLQ scores indicated that chronic coughers have more psychosocial issues than patients with bronchiectasis (p = 0.03) but less functional impairment than COPD patients (p = 0.04). There was a significant difference in generic health status across the four disease groups (p = 0.04), with poorest health status in COPD patients. A significant inverse correlation was observed between CQLQ and LCQ in each disease group (chronic cough r = - 0.56, p < 0.001; COPD r = - 0.49, p = 0.04; asthma r = - 0.94, p < 0.001; and bronchiectasis r = - 0.88, p < 0.001). There was no correlation between cough questionnaire scores and FEV(1) in any group, although a significant correlation between EuroQol visual analog scale component and FEV(1) (r = 0.639, p = 0.004) was observed in COPD patients. Cough adversely affects health status across a range of common respiratory diseases. The LCQ and CQLQ can each provide important additional information concerning the impact of cough.

12-year change in prevalence of respiratory symptoms in elderly Chinese living in Hong Kong

Respiratory diseases may cause considerable disability in the elderly because of their limited respiratory reserve related to aging. This study aimed to assess the time trend of respiratory symptoms and common chronic respiratory diseases in the elderly Chinese living in Hong Kong. Two questionnaire surveys were conducted in 1991-1992 and 2003-2004. Subjects aged > or = 70 years were invited to complete a respiratory questionnaire. A total of 2032 (999 male) and 1524 (698 male) subjects completed the questionnaire surveys in 1991 and 2003, respectively. The response rates were 60% in 1991 and 78% in 2003. The prevalence of most respiratory symptoms increased over time after adjusting the data for age, sex, social status and smoking habits. Comparing the symptoms between 1991 and 2003, wheeze over the past 12 months increased from 7.5 to 12.1% (adjusted OR 2.00, 95% CI 1.54-2.61) and morning chest tightness from 4.2 to 8.8% (adjusted OR 2.48, 95% CI 1.79-3.43). The prevalence of self-reported physician-diagnosed emphysema increased over time (2.4-3.1%, adjusted OR 1.78, 95% CI 1.12-2.86), but there was no change for asthma (5.1% in 1991 and 5.8% in 2003) or chronic bronchitis (6.7% in 1991 and 7.7% in 2003). The prevalence of respiratory symptoms has increased over the past 12 years and this may be related to environmental factors especially increasing air pollution in Hong Kong.

Chronic obstructive pulmonary disease: a phenomenological study of patients’ experiences

The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease by investigating the subjective phenomenon as described by the patient. Chronic obstructive pulmonary disease is now recognized as one of the most common chronic respiratory diseases in the United Kingdom, with a high prevalence of morbidity and mortality. As the disease progresses, symptoms increase which gradually influence all aspects of the lives of those affected by it. A phenomenological approach was identified as the most appropriate method to gain an understanding of living with chronic obstructive pulmonary disease. The data were obtained from 10 participants using unstructured interviews to capture detailed experiences verbatim. Analysis, based on the framework of Diekelmann et al. (The NLN Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, NLN Press, New York, 1989), was employed to interpret the data and determine shared themes that evolved during the course of the research. The data revealed valuable insights, from a patient's perspective, into the impact chronic obstructive pulmonary disease had on their daily lives. The accounts obtained from participants, many of who had severe chronic obstructive pulmonary disease, illustrate the detrimental effects of this debilitating disease. Breathlessness was identified as the most troublesome symptom leading to anxiety, panic and fear. Participants also described feeling frustrated and tired because of their breathlessness, which led to loss of social activity. This also resulted in a loss of their role within the family including loss of intimacy in personal relationships. Despite this, half of the participants felt they had a fairly good quality of life. The use of phenomenology as a research methodology fulfilled the aim of gaining a greater understanding of the experiences of living with chronic obstructive pulmonary disease. It provided valuable insights into how patients view the overall impact and their subsequent degree of coping with chronic obstructive pulmonary disease from day to day. Whilst there is no cure for chronic obstructive pulmonary disease and medical interventions have limited effect, health professionals can do much to improve patient's symptoms and experiences of living with chronic obstructive pulmonary disease by listening to how their symptoms affect them and adapting coping strategies. It is hoped that the themes revealed in this study generate additional understanding and insight for future innovative practice.

Study of adenosine deaminase activity in pulmonary tuberculosis and other common respiratory diseases

Tuberculosis has, in a short span of time, become a major health problem in the third world or developing countries like India. In view of this, a retrospective study was conducted to study Adenosine deaminase activity in serum and pleural fluid in patients affected with Pulmonary Tuberculosis and other common non-tubercular chronic respiratory diseases. The study was carried out on 100 patients suffering from various pulmonary disorders, between January 2002 and August 2002. Thirty-five normal healthy individuals were included as control subjects. ADA estimation was done by sensitive colorimetric method. The study revealed that the serum ADA activity was higher in patients of tuberculous pulmonary and pleural diseases and non-tuberculous pulmonary diseases than in control subjects. The mean serum ADA activity in the patients' group was 35.5±6.93 u/l as compared to 16.20±2.85 u/l in control group, showing a highly significant (P≪0.001) difference. ADA activity was highest in tuberculous pleuropulmonary diseases. The pleural fluid ADA activity was higher in pyogenic pleural effusion than in tuberculous pleural effusion.

Geographic variations in asthma mortality in Erie and Niagara counties, western New York, 1991-1996.

Asthma is one of the most common chronic respiratory diseases in the United States.1 More than 5000 persons died from asthma in 1995, and the trends in asthma mortality have been increasing in the United States over the past 2 decades.2 This investigation focused on Erie and Niagara counties in western New York. These counties have a combined population of 1.2 million and, together, are classified as a metropolitan area. Asthma mortality data for 1991 to 1996 were obtained from the New York State Bureau of Biometrics. Asthma mortality was determined from death certificate information. SPSS (SPSS, Inc, Chicago, Ill) was used in conducting statistical analyses. All population rates were calculated per 100 000 persons. Between 1991 and 1996, 158 asthma deaths were recorded in western New York. Eighty percent of these deaths occurred in Erie and Niagara counties. Average ageadjusted annual mortality rates were 1.61 for Erie County and 1.53 for Niagara County. In comparison, New York State had an average annual rate of 2.48 asthma deaths per 100 000 population. The majority of deaths (58%) during 1991 to 1996 occurred among individuals 65 years or older. The highest mortality rate for the period was 2.49 (95% confidence interval [CI] = 1.60, 3.38) in 1995; this rate decreased to 1.90 (95% CI = 1.12, 2.68) in 1996. Women had higher asthma mortality rates than men in Erie and Niagara counties (see Table 1 ▶). TABLE 1— Deaths From Asthma in Erie and Niagara Counties, by Age Group and Sex, 1991–1996 The city of Niagara Falls had an average annual asthma mortality rate of 2.96, almost 3 times that of the remainder of Niagara County (see Table 2 ▶). The city of Lockport had an annual mortality rate of 3.05, more than that of the rest of Erie County (1.09 per 100 000). Two zip codes in Buffalo's east side (14211 and 14215) accounted for 25% of the mortality from 1991 to 1996. TABLE 2— Deaths From Asthma, by Area: Western New York, 1991–1996 As a region, western New York had mortality rates lower than those in most of New York State. However, regional grouping masks areas of high risk for mortality due to asthma. Mortality was greatest in the 2 most populous counties (i.e., Erie and Niagara) and rare in rural counties of western New York. In Erie and Niagara counties, mortality was greater in urban areas than in suburban or rural areas. Buffalo, the most urbanized area in the 2 counties, had the highest annual mortality rate, comparable to that of New York City. Buffalo accounts for 20% of western New York's population but was responsible for 50% of asthma mortality in the region during the study period. The 2 zip codes with the highest asthma mortality rates in Buffalo comprise areas with large African American populations.3 Many US cities have large minority populations living in poverty, among whom the prevalence and severity of asthma are high.4–6 Given the reversibility of asthma and the availability of effective treatment strategies, deaths due to asthma are avoidable. The present report provides a basis for targeting interventions and evaluating their effectiveness.

Distinguishing chronic obstructive pulmonary disease from asthma.

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases in the UK. Good management of both diseases results in better symptom control and improved quality of life for the patient, but will rely on all members of the primary healthcare team sharing the aims of management as well as helping to implement those goals. The two diseases share many clinical features and similar drugs can be used to treat them both. However there are important clinical differences which help to distinguish them from each other. The management of the two diseases differs in drug regimens and in the long-term aims of management. This article clarifies the important features that distinguish asthma from COPD and which allow patients to receive the best specific management.

The dimensions of the chronic respiratory disease problem.

CHIIONIC respiratory disease, with the exception of pulmonary tuberculosis, has until recently been one of the most neglected disease categories in the modern practice of medicine.J To recognize the accuracy of this statement one has only to examine the evolution of our knowledge of bronchogenic carcinoma and other major chronic respiratory diseases. As late as three or four decades ago the physician and pathologist considered bronchogenic carcinoma a rare entity and failed to recognize its primary site or pulmonary origin. Instead, it was described as arising in the adjacent mediastinal structures, or was thought to be metastasized from what was later found to be its own metastases. Another example one might mention to illustrate this point would be pulmonary emphysema. Fifteen to twenty years ago emphysema was known as a clinical entity, but for practical purposes individuals were classified as those in whom the condition was marked by severe disabling symptoms and signs, and those in whom it was not. Various gross classifications were proposed, usually based on the posture of advanced emphysema patients now known to be the effect rather than the cause and certain roentgenographic or gross anatomical manifestations such as the presence of blebs or bullae or the absence of vascular markings, the socalled vanishing lung. It has been only in the past decade that the pathologists and anatomists have focused their attention on the significance of the primary lobule as the anatomical unit of the lung of particular importance in emphysema. and have offered a reasonable scientific classification of the disease. Histopathologic studies, coupled with recent advances in technics for testing pulmonary function, have called attention to the fact that emphysema is truly a chronic progressive disease, but that in many instances it may be arrested or its progression delayed, if detected early and proper measures are taken. Bronchial asthma, on the other hand, represents the one chronic respiratory disease concerning which we have accumulated detailed clinical information. This is largely due to the early discovery of bronchodilating hormones and drugs, such as epinephrine and ephedrine, for the relief of patients, and which have made possible laboratory and clinical investigation. This factor, which also stimulated and paralleled the advances made in the field of allergy during the past few decades, was responsible for our more extensive clinical knowledge of this disorder. However, paradoxical as it may seem, less statistical information is available on bronchospasm and asthma than for many of the other common chronic respiratory diseases. Chronic bronchitis, prior to the diagnostic advances of the past eight or nine years, represented one of the most perplexing diagnostic and clinical classification problems in the entire chronic respiratory disease field. As a surgeon, I can state frankly that for years the thoracic surgeons in this country and