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Rationale: The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD).Objectives: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors.Methods: The Burden of Obstructive Lung Disease study is a crosssectional study of adults, aged $40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV 1 -to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites.From these relative risks and the prevalence of risk factors, we estimated local population attributable risks. Measurements and Main Results:The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for $10 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites.Conclusions: Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.

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The thousands of patients attending general practitioners, hospitals, migraine clinics and non-medical practitioners and the profusion of drug regimes and physical methods offereu, all bear witness to the fact that the treatment of migraine and other sorts of headache is unsatisfactory. That this is so is realised by the public, who have become more interested in treatments that are offered outside the medical profession. Acupuncture in this country is provided by a great many non-medically qualified persons and a few doctors of medicine. Although uncontrolled clinical studies in more than twenty thousand patients at UCLA suggest that it may be a useful form of treatment for migraine and muscle tension headaches,' it continues to be considered a "fringe technique" .2In order to assess the usefulness of acupuncture in migraine and muscle tension headaches, a trial of acupuncture and standard medical treatment was undertaken; the results are presented in this report. The purpose of treatment was to prevent migraine and headaches or to reduce their number and severity; it was not to treat the headache when it occurred.

COPD is a debilitating and progressive condition in which the airways become irreversibly obstructed and the lungs progressively damaged. Unlike asthma, we know little about the cells that initiate and drive this process. Research has shown that CD8(+) T cells are overrepresented in the lungs of patients with COPD and that they are inversely related to lung function. However, not all CD8(+) T cells are alike and subsets that make IFN-gamma but not IL-4 (Tc1), IL-4 but not IFN-gamma (Tc2) as well as those that make both (Tc0) have been described. This article focuses on the characteristics of CD8(+) T cell subsets and considers their potential contribution to chronic obstructive pulmonary disease (COPD). Kemeny DM, Vyas B, Vukmanovic-Stejic M, Thomas M, Noble A, Loh LC, O'Connor BJ. CD8(+) T cell subsets and chronic obstructive pulmonary disease.