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1. Global Initiative for Chronic Obstructive Lung Disease (GOLD), Global strategy for
the diagnosis, management and prevention of chronic obstructive pulmonary
disease NHLBI/WHO Workshop Report. Executive Summary 2001. (
, : . , . , . , .
, . ).
2. Mannino DM, Brown C, Giovino GA, Obstructive lung disease deaths in the United
States from 1979 through 1993. An analysis using multiple cause mortality data,
Am. J. Respir. Crit. Care Med., 1997; 156: 814-8.
3. Xu X, Weiss ST, Rijcken B, Schouten JP., Smoking, changes in smoking habits, and
rate of morbidity in the United States, Am. Rev. Respir. Dis., 1994; 7: 1056-61.

182

, 2 1 .

4. Britton J, Knox ., Helping people to stop smoking: the new smoking cessation
guidelines, Thorax, 1999; 54: 1-2.
5. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T., The efficacy and cost
effectiveness of vaccination against influenza among elderly persons living in the
community, N. Engl. J. Med., 1994; 331:778-84.
6. Vathenen AS, Britton JR, Ebden P, Cookson JB, Wharrad HJ, Tattersfield AE.,
High-dose inhaled albuterol in severe chronic airflow limitation, Am. Rev. Respir.
Dis. 1988; 138: 850-5.
7. COMBIVENT Inhalation Solution Study Group, Routine nebulized ipratropium
and albuterol together are better than either alone in , Chest, 1997; 112:
1514-21.
8. Ulrik CS, Efficacy of inhaled salmeterol in the management of smokers with
chronic obstructive pulmonary disease: a single centre randomised, double blind,
placebo controlled, crossover study, Thorax, 1995; 50: 750-4.
9. The Lung Health Study Research Group, Effect of inhaled triamcinolone on the
decline in pulmonary function in chronic obstructive pulmonary disease, N. Engl.
J. Med., 2000; 343: 1902-9.
10. Deaamer M, Lacquet LM, Fagard R, Rogiers P. Corticosteroids contribute to muscle
weakness in chronic airflow obstruction, Am. J. Respir. Crit. Care Med, 1994; 150:11-6.
11. Nocturnal Oxygen Therapy Trial Group, Continuous or nocturnal oxygen therapy
in hypoxemic chronic obstructive lung disease: a clinical trial, Ann. Intern. Med.,
1980; 93: 391-8.
12. McGavin CR, Gupta SP, Lloyd EL, McHardy GJ., Physical rehabilitation for the
chronic bronchitis: results of a controlled trial of exercises in the home, Thorax,
1977; 32: 307-11.

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