Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.

Fourteen healthy, nonsmoking subjects were exposed to swine dust while weighing pigs for 3 to 5 h in a swine-confinement building. All but one participant was previously unexposed to swine dust. Bronchoalveolar lavage (BAL) was performed and blood samples were drawn before and after exposure. Total dust and endotoxins were measured by air sampling in filter cassettes carried in the breathing zone. The air concentration of endotoxins was 0.6 (range, 0.08 to 1.3) micrograms/m3, and of total dust was 13.5 (range, 5.6 to 24.0) mg/m3. The air concentrations of ammonia, carbon dioxide, and hydrogen sulfide were low. The exposure induced fever in three and malaise and drowsiness in six of the subjects. Compared with preexposure values, a 75-fold increase in neutrophilic granulocytes, a two- to threefold increase in mononuclear cells, and a significant increase in eosinophilic granulocytes were observed in the BAL fluid obtained 1 day (approximately 22 h) after exposure (p < 0.01 for all cell types). The fibronectin and albumin concentrations in the BAL fluid significantly increased (p < 0.01 for both). The number of leukocytes in peripheral blood was almost doubled 6 h after exposure and was still significantly elevated after 1 day. Blood concentrations of orosomucoid and C-reactive protein (CRP) were significantly increased 1 day after exposure. We conclude that exposure to swine dust in a swine-confinement building induces an intense inflammatory reaction in the airways as assessed by BAL. The airway cellular response is characterized by a dramatic increase in neutrophils. The components in the swine dust that cause the reaction are not clear.

Objective To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting β 2 agonist.

No abstract

In healthy subjects, acute inhalation of swine dust causes an influx of inflammatory cells into the airways and increased bronchial responsiveness. The exposure may also cause fever and generalized symptoms. It seems likely that proinflammatory cytokines are involved in the response to inhaled swine dust.Nasal and bronchoalveolar lavage (BAL) were performed before, and 7 and 24 h after the start of 3 h exposure to swine dust, during a period of work in a swine confinement building, in 22 healthy subjects. Lavage fluids were analysed with regard to the cellular response and concentrations of interleukin (IL)-1α, IL-1β, IL-6 and tumour necrosis factor-α (TNF-α). Each subject carried personal samplers for exposure measurements. Inhalable dust and airborne endotoxin, 3-hydroxylated (2-OH) fatty acid and muramic acid were measured. Bronchial responsiveness to methacholine was investigated 1-2 weeks before and 7 h after the start of the exposure.Exposure caused fever (>38°C) in three subjects, and approximately 25% of the subjects experienced symptoms. Bronchial responsiveness to methacholine increased by 3.5 (1.6-4.8) doubling doses (median (25th-75th percentile)). Following exposure, granulocytes increased more than 50 fold in BAL fluid and more than 40 fold in nasal lavage fluid. IL-1α and IL-1β increased significantly in BAL fluid (p<0.05) and nasal lavage fluid (p<0.01). IL-6 increased 25 fold in BAL and 15 fold in nasal lavage fluid (p<0.001). TNF-α was below detection limit (0.25 ng·L -1 ) in most subjects before exposure and increased following exposure to 3.8 (2.4-5.7) and 1.3 (0.6-2.3) ng·L -1 in BAL and nasal lavage fluid, respectively, (p<0.001). Total inhalable dust was 20.5 (14.6-30.0) mg·m -3 and the concentrations of airborne endotoxin, 3-OH fatty acid and muramic acid were 1.2 (0.8-1.4), 3.5 (2.2-4.5) and 0.9 (0.3-1.9) µg·m -3 , respectively. There was a significant correlation between the IL-6 response in BAL fluid and exposure to dust endotoxin activity and 3-OH fatty acids (p<0.05). Otherwise, no significant correlations were found between exposure and the cytokine response.We conclude that exposure to swine dust causes an intense upper and lower airway inflammation, which involves the proinflammatory cytokines interleukin-1, interleukin-6 and tumour necrosis factor-α.