Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720100013&lang=pt vol. 138 num. 12 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Myocardial lipids and creatine measured by magnetic resonance spectroscopy among patients with heart failure</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300001&lng=pt&nrm=iso&tlng=pt Background: Heart failure (HF) is characterized, among other features, by the development of alterations in myocardial energy metabolism, involving a decrease in glucose utilization and increased free fatty acid uptake by cardiomyocytes, associated with decreased deposits of high-energy phosphates (creatine phosphate/ creatine transporter). Magnetic resonance (MR) imaging allows a direct and noninvasive assessment of myocardial metabolites. Aim: To measure myocardial creatine and lipids by MR spectroscopy among patients with HF. Material and Methods: Cardiac MR spectroscopy (1.5 Tesla) with Hydrogen antenna and single voxel acquisition was performed in fve patients with non-ischemic heart failure, aged 58 ± 9.7 years, (60% males) and 5 healthy volunteers matched for age and sex. We analyzed the signals of creatine (Cr), lipids (L) and water (W) in the interventricular septum, establishing the water/lipid (W/L) and water/creatine (W/Cr) index to normalize the values obtained. Results: Among patients, left ventricular ejection fraction was 32 ± 6.9%, 60% were in functional capacity II, 60% had hypertension and one was diabetic. Spectroscopic curves showed a depletion of total Cr, evidenced by the W/ Cr index, among patients with heart failure, when compared with healthy controls (1.46 ± 1.21 and 5.96 ± 2.25 respectively, p < 0,05). Differences in myocardial lipid content, measured as the W/L index, were not significant (5.06 ± 2.66 and 1.80 ± 1.62 respectively, p = 0.08). Conclusions: Among patients with heart failure of non-ischemic etiology, there is a depletion of creatine levels measured by MR spectroscopy. <![CDATA[<b>Diagnostic yield of CT pulmonary angiography and venography for thromboembolic disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300002&lng=pt&nrm=iso&tlng=pt Background: CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism. Aim: To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64- slice multidetector tomography. Material and Methods: Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered. Results: A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36%) and isolated in the rest. Thirty fve of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10%) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30%) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT. Conclusions: The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors. <![CDATA[<b>Complications and mortality of extended gastrectomy for gastric cancer</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300003&lng=pt&nrm=iso&tlng=pt Background: Extended gastrectomy allows a complete tumor excision in patients with advanced gastric cancer. Aim: To compare the surgical results of extended (ER) and non-extended gastrectomy (NER) among patients with gastric cancer, and determine factors associated with complications and mortality. Material and Methods: Review of medical records of patients with gastric cancer who underwent complete resection between 2002 and 2008 in an oncological hospital. Demographics, patient-related and therapeutic features were compared between groups, and independent factors were established with multivariate analysis. Results: Seventy four patients, (44 men, median age 62 years) underwent an ER and 103 patients, (56 men, median age 61 years) a NER. Specifically, ER included splenectomy alone in 27 patients, splenectomy associated with other procedure in 24, partial esophagectomy in 18, distal pancreatectomy in 13, hemicolectomy in 8, total esophagectomy in 7, partial hepatectomy in 4, and adrenalectomy in 1. Postoperative complications were observed in 19 patients treated with an ER (26%) and in 11 patients treated with a NER (11%), p < 0.05. Serious complications were higher in patients who underwent an ER compared with NER (6 patients (8%) vs. 4 (4%), respectively) p < 0.05. In the same way, mortality was higher in patients treated with ER when it was compared with NER (4 patients (5%) vs two (2%), respectively), p < 0.05. ER and serum albumin levels were independent factors associated to a higher risk of mortality and rate of complications. Conclusions: ER was associated with a higher rate of general and severe complications, and mortality. <![CDATA[<b>Correlation between clinical evaluation of liver size versus ultrasonography evaluation according to body mass index (BMI) and biotypes</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300004&lng=pt&nrm=iso&tlng=pt Background: Body weight mayinfluence liver size. Aim: To determine the correlation between clinical and ultrasound evaluation of the liver size according to body mass index (BMI). Material and Methods: A cross-sectional study of 81 subjects aged 25 ± 6 years (43 females). Two percussion measurements were taken and u-trasonography was performed on the same site demarcated by percussion. Results: Mean BMI was 23 ± 4 kg/m². Nineteen individuals (23.5%) had a BMI ≥ 25 kg/m². There was a significant difference between the values of liver size obtained by clinical and ultrasound methods. The correlation coeffcient between the liver size obtained by clinical and ultrasound methods was 0.419 (p < 0.01). No significant differences in liver size were observed, between subjects with a BMI below or over 25 kg/m². In all subjects, regardless of BMI, there was a statistically significant difference between the mean sizes obtained by both methods. The correlation coeffcients between both methods in subjects with a BMI ≤ 25 Kg/m² and their counterparts with higher BMI were 0.47 and 0.03, respectively. Conclusions: There are significant differences in liver size obtained by clinical examination and ultrasound. Only in subjects with BMI ≤ 25 kg/m², the correlation between the two techniques is significant.<hr/>Introducción: El peso corporal puede tener influencia sobre el tamaño del hígado. Objetivo: Determinar el tamaño del hígado mediante examen físico y ultrasonido en sujetos con distinto índice de masa corporal (IMC). Material y Métodos: Estudio transversal de 81 individuos de 25 ± 6 años (43 mujeres). Se tomaron dos medidas del hígado por percusión y la ultrasonografía se efectuó en el mismo sitio marcado por la percusión. Resultados: El IMC promedio de los individuos fue de 23 ± 4 kg/m². Diecinueve sujetos (23,5%) tenían un IMC ≤ 25 kg/m². Se observaron diferencias significativas entre las mediciones obtenidas por examen físico y ultrasonografía en todos los sujetos, no importando el valor de IMC. No se observaron diferencias en el tamaño del hígado entre sujetos con un IMC menor o mayor a 25 kg/m². Los coeficientes de correlación entre los dos métodos en sujetos con un IMC ≤ 25 kg/m² y aquellos con valores más altos fueron 0,47 y 0,03, respectivamente. Conclusiones: Las mediciones clínicas y ultrasonográficas del tamaño del hígado diferen signifcativamente. Sólo en sujetos con un IMC ≤ 25 kg/m², ambas mediciones tienen una correlación significativa. <![CDATA[<b>Analysis of a scale for the assessment of attention deficit disorder with hyperactivity in Chilean children</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300005&lng=pt&nrm=iso&tlng=pt Background: Epidemiologic studies may be used as a starting point to improve interventions and improve diagnosis, with instruments that are both reliable and adequate. Aim: To analyze the psychometric properties of the Attention Defcit Disorder Evaluation Scale (ADDES) in Chilean primary and high school students. Material and Methods: The ADDES was applied by 142 teachers to 254 students. Attention Defcit Disorder was already diagnosed in 144 students. Explanatory and confirmatory factorial analyses were carried out. Results: Confirmatory Factorial Analysis (CFA) proved that the model suggested by the authors could not be replicated in the Chilean sample. Exploratory Factorial Analysis (EFA) showed that three new factors came out of the analysis. CFA was applied to the new model and modification indexes suggested the introduction of new saturations. Based on the model with the best goodness-of-fit, psychometric characteristics were evaluated. Conclusions: The ADDES adapted to the Chilean context has a high reliability and a strong discrimination ability, allowing the evaluation of behavior disorders, hyperactivity/impulsivity and attention deficit. <![CDATA[<b>Spermograms of healthy young subjects living in Arica, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300006&lng=pt&nrm=iso&tlng=pt Background: Semen analysis is one of the parameters used to predict male fertility. Semen can be altered by environmental pollutants; therefore it could be used as a biological marker of exposure in contaminated areas. Aim: To analyze the spermogram values in a sample of healthy young males, residing in Arica, Chile. Material and methods: One hundred and two healthy university students volunteers aged 18 to 30 years answered a questionnaire about fertility, habits and andrologic diseases and provided a semen sample. Within three hours after ejaculation, semen volume, pH, sperm concentration, motility and morphology were analyzed. Results: Six percent of volunteers had offspring, 1% declared to be infertile, 32% smoked and 78% con-sumed alcohol. Semen pH was 7.6 ± 0.5, volume, 2.9 ± 1.6 ml, sperm concentration, 62.8 ± 62.3 x 10(6)/ml, normal morphology, 15.0 ± 7.9%, overall motility, 42.2 ± 23.2 % and grade A motility, 19.2 ± 18.6%. The percentage of subjects that had normal semen values was 82% for total sperm count, 76% for sperm concentration, 72% for volume, 64% for vitality, 63% for pH, 57% for morphology, 38% for overall motility and 26% for grade A motility. Conclusions: This sample of healthy young males had a normal sperm count in comparison with international reports. However it is necessary to characterize the spermogram in uncontaminated areas of Chile to ensure that our results are within the expected values for the country. <![CDATA[<b>The work environment as a source of exposure to secondhand smoke</b>: <b>a study in workers of bars and restaurants of Santiago, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300007&lng=pt&nrm=iso&tlng=pt Background: Secondhand smoke (SHS) is an established cause of morbidity and mortality among non-smokers. The workplace is an important source of exposure, especially among workers of restaurants, bars and nightclubs. Aim: To estimate the daily occupational exposure to SHS among non-smoking workers of bars and restaurants of Santiago, Chile. Material and Methods: Environmental vapor-phase nico-tine was measured for 95 non-smoking workers of bars and restaurants of Santiago, using passive personal samplers during a daily work shift and outside the workplace. Results: The median occupational exposure to air nicotine was 9.18 µg/m³ (P25-P75 3.15-25.67 µg/m³). Higher concentrations were found among workers of places with no smoking restrictions (22.72 µg/m³; P25-P75 5.73-34.85 µg/m³), bar workers (20.75 µg/m³, P25-P75 5.03-44.67 µg/m³), waiters (20.57 µg/m³, PP25-P75 5.66-42.73 µg/m3) and bartenders (10.37 µg/m³, P25-P75 9.75-25.67 µg/m³). The median concentration of nicotine outside the workplace was 1.79 µg/m³ (P25-P75 1.02-3.00 µg/m³). Occupational exposure was 4.77 times higher compared to the non-work exposure. Conclusions: Workers of bars and restaurants are exposed to high levels of SHS at the workplace. Moreover, occupational exposure among these non-smoking workers is, in most cases, the main source of daily exposure to this pollutant. <![CDATA[<b>Frequency of prescription and transcription errors for intravenous medications in four pediatric services</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300008&lng=pt&nrm=iso&tlng=pt Background: Errors in the prescription and transcription of medications in pediatric services is a source of adverse events that can be prevented. Aim: To determine and compare the frequency of prescription and transcription errors for intravenous drugs in four pediatric services in a regional general hospital. Material and Methods: Cross sectional analysis of a probabilistic sample of 500 prescriptions of intravenous medications. Information was gathered using an instrument from the American Academy of Pediatrics. Results: The detected prescription errors were illegible indications in 20%, lack of dosing indication in 11%, omission of the administration route in 24% and omission of the frequency of administration in 15%. Transcription errors were illegible transcription in 3%, not transcribing all indicated medications in 4% and transcription of medications that were not prescribed in 3%. Twenty one percent of prescriptions and 6% of transcriptions had at least one incorrect action. In the different services studied there was a significant association between the percentage of incorrect prescriptions and transcriptions and between illegible prescriptions and transcriptions. Conclusions: A high percentage of errors in prescription of intravenous medications and their transcriptions, was detected in these services. A better quality of care control is required. <![CDATA[<b>Molecular and genetic studies for hereditary colon cancer in two patients and their families</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300009&lng=pt&nrm=iso&tlng=pt Background: About 30% of cases of colon cancer (CC) have a family history of CC, and only 5% are hereditary forms. Hereditary forms have an increased risk of CC and other tumors. Aim: To report the molecular and genetic study in two families with hereditary CC. Material and Methods: Molecular analysis of the adenomatous polyposis coli (APC) gene of familial adenomatous polyposis (FAP), was done in a patient with multiple benign polyps and his children. Molecular analysis was performed for MLH1 gene mutation of hereditary non-polyposis colon cancer (HNPCC) in an asymptomatic patient with family history of multiple cancers and his mother with a confrmed mutation in the MLH1 gene. Results: The patient with FAP had an insertion of 17 base pairs in exon 9 of the APC gene and two of his children had the same mutation. The patient with history of HNPCC did not have the family mutation on MLH1. Conclusions: In the case of FAP, molecular study was performed in his children since manifestations in carriers of the mutation may begin in childhood. If the second patient would have had the mutation, the study of his children could have been postponed until the age of 18, when the risk for CC is increased. <![CDATA[<b>Mesenteric cryptococcal lymphadenitis</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300010&lng=pt&nrm=iso&tlng=pt Cryptococcosis is an invasive mycotic infection caused by Cryptococcus neoformans, an encapsulated, yeast-like fungus. It is considered an opportunist infection, since it mainly affects immunocompromised subjects. However there are isolated reports of the infection in immunocompetent subjects. Cryptococcal infection of intra-abdominal organs or tissues is extremely rare. We report a 21-year-old HIV positive male that, during the treatment of a meningeal cryptococcosis, presented a clinical picture of an acute abdomen suggesting acute appendicitis. The patient was operated, finding enlarged mesenteric lymph nodes forming conglomerates and a macroscopically normal appendix. The conglomerated lymph nodes and the appendix were excised. The pathological study of the surgical piece revealed an intra abdominal cryptococcal lymphadenitis and a normal appendix. <![CDATA[<b>Splenic gangrene due to Streptococcus anginosus after a sleeve gastrectomy</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300011&lng=pt&nrm=iso&tlng=pt We report a 46-year-old woman, subjected to a laparoscopic sleeve gastrectomy, that had to be converted to open surgery due to the presence of adherences. She required an immediate new intervention due to a hemoperitoneum caused by a liver tear and venous bleeding from the splenic hilus. Both lesions were successfully repaired. In the postoperative period the patient had fever, leukocytosis and sialorrhea. A CAT scan showed a splenic infarction and a huge intra abdominal collection that communicated with the stomach. Streptococcus anginosus was isolated from the collection. The patient was managed with antimicrobials and percutaneous drainage with a favourable evolution and closure of the communication with the stomach. <![CDATA[<b>Update on chronic obstructive pulmonary disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300012&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b>Keynote address to the 19<sup>th</sup> congress of ALANAM</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300013&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b>The ALANAM statement on public health policy</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300014&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b><i>19th Meeting of the Governing Board of ALANAM (Association of National Academies of Medicine of Latin America, Spain and Portugal)</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300015&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b>Neurofbromatosis type I and antiphospholipid syndrome</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300016&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b><i>Clinical ethics consultation in intensive care</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300017&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable. <![CDATA[<b>FE DE ERRATUM</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001300018&lng=pt&nrm=iso&tlng=pt Chronic obstructive pulmonary disease (COPD), mainly caused by smoking, is predicted to be the third most frequent cause of death in the world by 2020. It is a multicomponent, progressive, disabling condition that ultimately ends in respiratory failure and death. There is evidence that systemic inflammation and extra pulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD is not only preventable but also treatable and the past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientifc evidence now documents the efficacy of several therapies for symptoms and exacerbations. It is clear that many patients with the disease can beneft from an aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. Moreover, basic and clinical scientists have now identifed cells, mechanisms, and molecules that play key roles in its pathogenesis. The advent of newer and more effective therapies will lead to a decline in the contribution of this disease to worldwide disease burden. COPD is now viewed under a new paradigm as preventable and treatable.