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January 15, 1997, Vol 277, No. 3 >
ARTICLE | January 15, 1997

Building a National Strategy for the Prevention and Management of and Research in Chronic Obstructive Pulmonary Disease: Title and subTitle BreakNational Heart, Lung, and Blood Institute Workshop Summary FREE

Thomas L. Petty, MD; Gail G. Weinmann, MD
[+] Author Affiliations

The workshop was held in Bethesda, Md, on August 29-31,1995, and was sponsored by the Division of Lung Diseases, National Heart, Lung, and Blood Institute. A complete list of speakers appears at the end of this article.

Dr Petty is a member of the speakers bureaus of Boehringer Ingelheim, Glaxo, and 3M.

Reprints: Gail G. Weinmann, MD, Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, MSC 7952, Bethesda, MD 20892-7952.


JAMA. 1997;277(3):246-253. doi:10.1001/jama.1997.03540270072029
Text Size: A A A
Published online
Article
References

CHRONIC obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the United States, exceeded only by heart attacks, cancers, and stroke. It is estimated that in 1996 more than 100 000 people will die of COPD alone, though for many more COPD will be a contributing cause of death. The recently completed Lung Health Study, sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) showed that sustained smoking cessation can be successful with coordinated intervention in up to 22% of subjects at risk of developing COPD.1 During the 5-year follow up period, smoking cessation resulted in a initial slight improvement then a slower rate of FEV1 decline compared with continued smokers. Since the rate of FEV1 decline is a powerful prognostic indicator, these results show not only the potential importance of early intervention, but also the

REFERENCES

1 +
Anthonisen NR, Connett JE, Altose MD, et al.  Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study . JAMA . 1994;;272:1497-1505.
2 +
Korol E.  The correlation of carcinoma and congenital cystic emphysema of the lungs: report of 10 cases . Dis Chest . 1953;;23:403-441.
3 +
Goldstein MJ, Snider GL, Liberson M, Poske RM.  Bronchogenic carcinoma and giant bullous disease . Am Rev Respir Dis . 1968;;97:1062-1070.
4 +
Skillrud DM, Offord KP, Miller RD.  Higher risk of lung cancer in chronic obstructive pulmonary disease: a prospective, matched controlled study . Ann Intern Med . 1986;;105:502-518.
5 +
Tockman MS, Anthonisen NR, Wright EC, Donithan MG.  Airways obstruction and the risk for lung cancer . Ann Intern Med . 1987;;106:512-518.
6 +
Kuller LH, Ockene J, Meilahn E, Svendsen KH.  Relation of forced expiratory volume in one second (FEV1) to lung cancer mortality in the Multiple Risk Factor Intervention Trial (MRFIT) . Am J Epidemiol . 1990;;132:265-274.
7 +
Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P.  Ventilatory function and chronic mucous hypersecretion as predictors of death from lung cancer . Am Rev Respir Dis . 1990;;141:613-617.
8 +
Nomura A, Stemmermann GN, Chyou P, Marcus EB, Buist AS.  Prospective study of pulmonary function and lung cancer . Am Rev Respir Dis . 1991;;144:307-311.
9 +
Islam SS, Schottenfeld D.  Declining FEV, and chronic productive cough in cigarette smokers: a 25-year prospective study of lung cancer incidence in Tecumseh, Michigan . Cancer Epidemiol Biomarkers Prev . 1994;;3:289-298.
10 +
Dawber TR, Kannel WB, Friedman GD.  Vital capacity, physical activity and coronary heart disease . In: Raab W, ed. Prevention of Ischemic Heart Disease: Principles and Practice . Springfield, Ill: Charles C Thomas; 1966;:254-265.
11 +
Kannel WB, Hubert H, Lew EA.  Vital capacity as a predictor of cardiovascular disease: the Framingham Study . Am Heart J . 1983;;105:311-315.
12 +
Friedman GD, Klatsky AL, Siegelaub MS.  Lung function and risk of myocardial infarction and sudden death . N Engl J Med . 1976;;294:1071-1075.
13 +
Marcus EB, Curb ID, MacLean CL, Reed DM, Yano K.  Pulmonary function as a predictor of coronary heart disease . Am J Epidemiol . 1989;;129:97-104.
14 +
Tockman MS, Pearson JD, Fleg JL, et al.  Rapid decline in FEV1: a new risk factor for coronary heart disease mortality . Am J Respir Crit Care Med . 1995;;151:390-398.
15 +
Snider GL, Faling LJ, Rennard SL.  Chronic bronchitis and emphysema . In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1994;:1331-1397.
16 +
 ATS Standards for Diagnosis and Care of Patients With Chronic Obstructive Pulmonary Disease, Definitions, Epidemiology, Pathophysiology and Staging . Am Rev Respir Dis . 1995;;152:578-584.
17 +
American Thoracic Society.  Lung function testing: selection of reference values and interpretative strategies . Am Rev Respir Dis . 1991;;144:1202-1218.
18 +
Becklake MR, White N.  Sources of variation in spirometric measurements: identifying the signal and dealing with noise . Occup Med State Art Rev . 1993;;8:241-264.
19 +
US Dept of Health and Human Services. The Health Consequences of Smoking: Chronic Obstructive Lung Disease: A Report of the Surgeon General. Washington, DC: US Dept of Health and Human Services; Public Health Service, Office on Smoking and Health; 1984:568. DHHS publication No. PHS 84-50205.
20 +
Britten N, Davies JMC, Colley JRT.  Early respiratory experience and subsequent cough and peak expiratory flow rate in 36 year old men and women . BMJ . 1987;;294:1317-1320.
21 +
Tashkin DP, Altose MD, Connett J, Kanner R, Lee W, Wise RA.  Methacholine reactivity predicts changes in lung function over time in smokers with early COPD: the Lung Health Study Research Group . Am J Respir Crit Care Med . 1996;;153:1802-1811.
22 +
Burge PS.  Occupation and chronic obstructive pulmonary disease (COPD) . Eur Respir J . 1994;;7:1032-1034.
23 +
Becklake MR. The work relatedness of airways dysfunction. In: Proceedings of the 9th International Symposium on Epidemiology in Occupational Health. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 1994:1-29. DHSS NIOSH publication No. 94-112.
24 +
Spitzer WO, Lawrence V, Dales R, et al.  Links between passive smoking and disease: a best evidence synthesis: a report of a working group on passive smoking . Clin Invest Med . 1990;;13:17-42.
25 +
Leaderer BP, Samet JM.  Passive smoking and adults: new evidence for adverse effects . Am J Respir Crit Care Med . 1994;;150:1216-1218.
26 +
Last JM, ed. A Dictionary of Epidemiology: A Handbook Sponsored by the IE A . 2nd ed. New York, NY: Oxford University Press; 1988;:59.
27 +
Becklake MR, Lailoo UG:  The 'healthy smoker': a phenomenon of health selection? Respiration . 1990;;57:137-144.
28 +
US Dept of Health, Education, and Welfare. Vital Statistics of the United States, 1974, Volume I. Washington, DC: National Office of Vital Statistics; 1977.
29 +
Webster JR, Kettel LJ, Moran F, et al.  Chronic obstructive pulmonary disease: a comparison between men and women . Am Rev Respir Dis . 1968;;98:1021-1026.
30 +
Chen Y, Horne SL, Dosman JA.  Increased susceptibility to lung dysfunction in female smokers . Am Rev Respir Dis . 1991;;143:1224-1230.
31 +
Coultas DB, et al.  Respiratory diseases in minorities of the United States . Am J Respir Crit Care Med . 1993;;149:S93-S131.
32 +
McWhorter WM.  Occurrence, predictors, and consequences of adult asthma in NHANES I and followup survey . Am Rev Respir Dis . 1989;;139:721-724.
33 +
Samet JM, Schrag JM, Howard CA, et al.  Respiratory disease in a New Mexico population sample of Hispanic and non-Hispanic whites . Am Rev Respir Dis . 1982;;125:152-157.
34 +
Samet JM, Coultas DB, Howard CA, et al.  Respiratory disease and cigarette smoking in a Hispanic population in New Mexico . Am Rev Respir Dis . 1988;;137:815-819.
35 +
Marcus EB, Buist AS, Curb JD, et al.  Correlates of FEV1 and prevalence of pulmonary conditions in Japanese-American men . Am Rev Respir Dis . 1988;;138:1398-1404.
36 +
Buist AS, Vollmer WM, Wu Y, et al.  Effects of cigarette smoking on lung function in four population samples in the People's Republic of China . Am J Respir Crit Care Med . 1995;;151:1393-1400.
37 +
Asian American Health Forum. Asian and Pacific Islander American Proportionate Mortality Ratios. San Francisco, Calif: Asian American Health Forum; 1990. Monograph series 2.
38 +
Fiore MC, Smith SS, Jorenby PE, et al.  The effectiveness of nicotine patch for smoking cessation: a meta-analysis . JAMA . 1994;;271:1940-1947.
39 +
Wedzicha JA.  Inhaled corticosteroids in COPD: awaiting controlled trials . Thorax . 1993;;48:305-307.
40 +
Alpha 1-Antitrypsin Deficiency Registry Study Group.  A registry of patients with severe deficiency of alpha 1-antitrypsin . Chest . 1994;;106:1223-1232.
41 +
Regelman WE, Elliott GR, Warwick WJ, et al.  Reduction of sputum PA density by antibiotics improve lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone . Am Rev Respir Dis . 1990;;141:914-921.
42 +
Anthonisen NR, Manfreda J, Warren CP, et al.  Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease . Ann Intern Med . 1987;;106:106-204.
43 +
Braun SR, McKenzie WN, Copeland C, et al.  A comparison of the effect of ipratropium and albuterol in the treatment of chronic obstructive airway disease . Arch Intern Med . 1989;;149:544-547.
44 +
Petty TL.  The combination of ipratropium and albuterol is more effective than either agent alone . Chest . 1995;;107( (suppl) ):183S-186S.
45 +
Weinberger M, Handels L.  Theophylline in asthma . N Engl J Med . 1996;;334:1380-1387.
46 +
Albert RK, Martin TR, Lewis RW.  Controlled clinical trials of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency . Ann Intern Med . 1980;;92:753-758.
47 +
Petty TL.  Home oxygen, a revolution in the care of advanced COPD . Med Clin North Am . 1990;;74:715-729.
48 +
Ries AL, Kaplan RM, Limberg TM, et al.  Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease . Ann Intern Med . 1995;;122:823-832.
49 +
Thompson RS, Taplin SH, McAfee TA, Mandelson MT, Smith AE.  Primary and secondary prevention services in clinical practice . JAMA . 1995;;273:1130-1135.
50 +
Schauffler HH, Parkinson MD.  Health insurance coverage for smoking cessation services . Health Educ Q . 1993;;20:185-206.
51 +
Wagner EH, Curry SJ, Grothaus L, Saunders KW, McBride CM.  The impact of smoking and quitting on health care use . Arch Intern Med . 1995;;155:1789-1795.
52 +
US Dept of Health and Human Services. The Health Benefits of Smoking Cessation. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. DHHS publication No. CDC 90-8416.
53 +
Stevens VJ, Glasgow RE, Hollis JF, et al.  A smoking cessation intervention for hospitalized patients . Med Care . 1993;;31:65-72.
54 +
Morris JF, Temple W.  Spirometric 'lung age' estimation for motivating smoking cessation . Prev Med . 1985;;14:655-662.
55 +
Kassirer JP.  Access to specialty care . N Engl J Med . 1994;;331:1151-1153.
56 +
Brown JJ, Sullivan G.  Effect on ICU mortality of a full-time critical care specialist . Chest . 1989;;96:127-129.
57 +
Freund DA, Stein J, Hurley R, et al.  Specialty differences in the treatment of asthma . J Allergy Clin Immunol . 1989;;84:401-406.
58 +
Strauss MJ, Conrad D, LoGerfo JP, et al.  Cost and outcome of care for patients with chronic obstructive lung disease: analysis by physician specialty . Med Care . 1986;;24:915-924.
59 +
Mossman BT, Mason R, McDonald JA, et al.  NHLBI Workshop Summary Advances in Molecular Genetics, Transgenic Models, and Gene Therapy for the Study of Pulmonary Diseases . Am J Respir Crit Care Med . 1995;;151:2065-2069.
60 +
Lenfant C.  New genetic approaches: establishing resources for research . Circulation . 1995;;91:1311-1312.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Anthonisen NR, Connett JE, Altose MD, et al.  Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study . JAMA . 1994;;272:1497-1505.
2 +
Korol E.  The correlation of carcinoma and congenital cystic emphysema of the lungs: report of 10 cases . Dis Chest . 1953;;23:403-441.
3 +
Goldstein MJ, Snider GL, Liberson M, Poske RM.  Bronchogenic carcinoma and giant bullous disease . Am Rev Respir Dis . 1968;;97:1062-1070.
4 +
Skillrud DM, Offord KP, Miller RD.  Higher risk of lung cancer in chronic obstructive pulmonary disease: a prospective, matched controlled study . Ann Intern Med . 1986;;105:502-518.
5 +
Tockman MS, Anthonisen NR, Wright EC, Donithan MG.  Airways obstruction and the risk for lung cancer . Ann Intern Med . 1987;;106:512-518.
6 +
Kuller LH, Ockene J, Meilahn E, Svendsen KH.  Relation of forced expiratory volume in one second (FEV1) to lung cancer mortality in the Multiple Risk Factor Intervention Trial (MRFIT) . Am J Epidemiol . 1990;;132:265-274.
7 +
Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P.  Ventilatory function and chronic mucous hypersecretion as predictors of death from lung cancer . Am Rev Respir Dis . 1990;;141:613-617.
8 +
Nomura A, Stemmermann GN, Chyou P, Marcus EB, Buist AS.  Prospective study of pulmonary function and lung cancer . Am Rev Respir Dis . 1991;;144:307-311.
9 +
Islam SS, Schottenfeld D.  Declining FEV, and chronic productive cough in cigarette smokers: a 25-year prospective study of lung cancer incidence in Tecumseh, Michigan . Cancer Epidemiol Biomarkers Prev . 1994;;3:289-298.
10 +
Dawber TR, Kannel WB, Friedman GD.  Vital capacity, physical activity and coronary heart disease . In: Raab W, ed. Prevention of Ischemic Heart Disease: Principles and Practice . Springfield, Ill: Charles C Thomas; 1966;:254-265.
11 +
Kannel WB, Hubert H, Lew EA.  Vital capacity as a predictor of cardiovascular disease: the Framingham Study . Am Heart J . 1983;;105:311-315.
12 +
Friedman GD, Klatsky AL, Siegelaub MS.  Lung function and risk of myocardial infarction and sudden death . N Engl J Med . 1976;;294:1071-1075.
13 +
Marcus EB, Curb ID, MacLean CL, Reed DM, Yano K.  Pulmonary function as a predictor of coronary heart disease . Am J Epidemiol . 1989;;129:97-104.
14 +
Tockman MS, Pearson JD, Fleg JL, et al.  Rapid decline in FEV1: a new risk factor for coronary heart disease mortality . Am J Respir Crit Care Med . 1995;;151:390-398.
15 +
Snider GL, Faling LJ, Rennard SL.  Chronic bronchitis and emphysema . In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1994;:1331-1397.
16 +
 ATS Standards for Diagnosis and Care of Patients With Chronic Obstructive Pulmonary Disease, Definitions, Epidemiology, Pathophysiology and Staging . Am Rev Respir Dis . 1995;;152:578-584.
17 +
American Thoracic Society.  Lung function testing: selection of reference values and interpretative strategies . Am Rev Respir Dis . 1991;;144:1202-1218.
18 +
Becklake MR, White N.  Sources of variation in spirometric measurements: identifying the signal and dealing with noise . Occup Med State Art Rev . 1993;;8:241-264.
19 +
US Dept of Health and Human Services. The Health Consequences of Smoking: Chronic Obstructive Lung Disease: A Report of the Surgeon General. Washington, DC: US Dept of Health and Human Services; Public Health Service, Office on Smoking and Health; 1984:568. DHHS publication No. PHS 84-50205.
20 +
Britten N, Davies JMC, Colley JRT.  Early respiratory experience and subsequent cough and peak expiratory flow rate in 36 year old men and women . BMJ . 1987;;294:1317-1320.
21 +
Tashkin DP, Altose MD, Connett J, Kanner R, Lee W, Wise RA.  Methacholine reactivity predicts changes in lung function over time in smokers with early COPD: the Lung Health Study Research Group . Am J Respir Crit Care Med . 1996;;153:1802-1811.
22 +
Burge PS.  Occupation and chronic obstructive pulmonary disease (COPD) . Eur Respir J . 1994;;7:1032-1034.
23 +
Becklake MR. The work relatedness of airways dysfunction. In: Proceedings of the 9th International Symposium on Epidemiology in Occupational Health. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 1994:1-29. DHSS NIOSH publication No. 94-112.
24 +
Spitzer WO, Lawrence V, Dales R, et al.  Links between passive smoking and disease: a best evidence synthesis: a report of a working group on passive smoking . Clin Invest Med . 1990;;13:17-42.
25 +
Leaderer BP, Samet JM.  Passive smoking and adults: new evidence for adverse effects . Am J Respir Crit Care Med . 1994;;150:1216-1218.
26 +
Last JM, ed. A Dictionary of Epidemiology: A Handbook Sponsored by the IE A . 2nd ed. New York, NY: Oxford University Press; 1988;:59.
27 +
Becklake MR, Lailoo UG:  The 'healthy smoker': a phenomenon of health selection? Respiration . 1990;;57:137-144.
28 +
US Dept of Health, Education, and Welfare. Vital Statistics of the United States, 1974, Volume I. Washington, DC: National Office of Vital Statistics; 1977.
29 +
Webster JR, Kettel LJ, Moran F, et al.  Chronic obstructive pulmonary disease: a comparison between men and women . Am Rev Respir Dis . 1968;;98:1021-1026.
30 +
Chen Y, Horne SL, Dosman JA.  Increased susceptibility to lung dysfunction in female smokers . Am Rev Respir Dis . 1991;;143:1224-1230.
31 +
Coultas DB, et al.  Respiratory diseases in minorities of the United States . Am J Respir Crit Care Med . 1993;;149:S93-S131.
32 +
McWhorter WM.  Occurrence, predictors, and consequences of adult asthma in NHANES I and followup survey . Am Rev Respir Dis . 1989;;139:721-724.
33 +
Samet JM, Schrag JM, Howard CA, et al.  Respiratory disease in a New Mexico population sample of Hispanic and non-Hispanic whites . Am Rev Respir Dis . 1982;;125:152-157.
34 +
Samet JM, Coultas DB, Howard CA, et al.  Respiratory disease and cigarette smoking in a Hispanic population in New Mexico . Am Rev Respir Dis . 1988;;137:815-819.
35 +
Marcus EB, Buist AS, Curb JD, et al.  Correlates of FEV1 and prevalence of pulmonary conditions in Japanese-American men . Am Rev Respir Dis . 1988;;138:1398-1404.
36 +
Buist AS, Vollmer WM, Wu Y, et al.  Effects of cigarette smoking on lung function in four population samples in the People's Republic of China . Am J Respir Crit Care Med . 1995;;151:1393-1400.
37 +
Asian American Health Forum. Asian and Pacific Islander American Proportionate Mortality Ratios. San Francisco, Calif: Asian American Health Forum; 1990. Monograph series 2.
38 +
Fiore MC, Smith SS, Jorenby PE, et al.  The effectiveness of nicotine patch for smoking cessation: a meta-analysis . JAMA . 1994;;271:1940-1947.
39 +
Wedzicha JA.  Inhaled corticosteroids in COPD: awaiting controlled trials . Thorax . 1993;;48:305-307.
40 +
Alpha 1-Antitrypsin Deficiency Registry Study Group.  A registry of patients with severe deficiency of alpha 1-antitrypsin . Chest . 1994;;106:1223-1232.
41 +
Regelman WE, Elliott GR, Warwick WJ, et al.  Reduction of sputum PA density by antibiotics improve lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone . Am Rev Respir Dis . 1990;;141:914-921.
42 +
Anthonisen NR, Manfreda J, Warren CP, et al.  Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease . Ann Intern Med . 1987;;106:106-204.
43 +
Braun SR, McKenzie WN, Copeland C, et al.  A comparison of the effect of ipratropium and albuterol in the treatment of chronic obstructive airway disease . Arch Intern Med . 1989;;149:544-547.
44 +
Petty TL.  The combination of ipratropium and albuterol is more effective than either agent alone . Chest . 1995;;107( (suppl) ):183S-186S.
45 +
Weinberger M, Handels L.  Theophylline in asthma . N Engl J Med . 1996;;334:1380-1387.
46 +
Albert RK, Martin TR, Lewis RW.  Controlled clinical trials of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency . Ann Intern Med . 1980;;92:753-758.
47 +
Petty TL.  Home oxygen, a revolution in the care of advanced COPD . Med Clin North Am . 1990;;74:715-729.
48 +
Ries AL, Kaplan RM, Limberg TM, et al.  Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease . Ann Intern Med . 1995;;122:823-832.
49 +
Thompson RS, Taplin SH, McAfee TA, Mandelson MT, Smith AE.  Primary and secondary prevention services in clinical practice . JAMA . 1995;;273:1130-1135.
50 +
Schauffler HH, Parkinson MD.  Health insurance coverage for smoking cessation services . Health Educ Q . 1993;;20:185-206.
51 +
Wagner EH, Curry SJ, Grothaus L, Saunders KW, McBride CM.  The impact of smoking and quitting on health care use . Arch Intern Med . 1995;;155:1789-1795.
52 +
US Dept of Health and Human Services. The Health Benefits of Smoking Cessation. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. DHHS publication No. CDC 90-8416.
53 +
Stevens VJ, Glasgow RE, Hollis JF, et al.  A smoking cessation intervention for hospitalized patients . Med Care . 1993;;31:65-72.
54 +
Morris JF, Temple W.  Spirometric 'lung age' estimation for motivating smoking cessation . Prev Med . 1985;;14:655-662.
55 +
Kassirer JP.  Access to specialty care . N Engl J Med . 1994;;331:1151-1153.
56 +
Brown JJ, Sullivan G.  Effect on ICU mortality of a full-time critical care specialist . Chest . 1989;;96:127-129.
57 +
Freund DA, Stein J, Hurley R, et al.  Specialty differences in the treatment of asthma . J Allergy Clin Immunol . 1989;;84:401-406.
58 +
Strauss MJ, Conrad D, LoGerfo JP, et al.  Cost and outcome of care for patients with chronic obstructive lung disease: analysis by physician specialty . Med Care . 1986;;24:915-924.
59 +
Mossman BT, Mason R, McDonald JA, et al.  NHLBI Workshop Summary Advances in Molecular Genetics, Transgenic Models, and Gene Therapy for the Study of Pulmonary Diseases . Am J Respir Crit Care Med . 1995;;151:2065-2069.
60 +
Lenfant C.  New genetic approaches: establishing resources for research . Circulation . 1995;;91:1311-1312.

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