In conclusion it may be stated that both green and black tea polyphenols are important components of antitumor aspect of complementary and alternative medicine (CAM), which play a significant role in the American health care system and in patients who suffer from chronic problems (43) . While green tea catechin gallates such as EGCG and ECG possess potent antitumor activities, their epimers, commonly found in black tea, act as potent inhibitor of proteases involved in replication of viruses, including coronoviruses (44) . There is a need to understand preventive and therapeutic potential of catechin gallates from both green and black teas. We are currently designing a phase I chemopreventive study to examine the effects of purified EGCG and ECG in patients who have been chosen observational management of organ-confined prostate cancer. Markers of exacerbation severity in chronic obstructive pulmonary disease BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can experience 'exacerbations' of their conditions. An exacerbation is an event defined in terms of subjective descriptors or symptoms, namely dyspnoea, cough and sputum that worsen sufficiently to warrant a change in medical management. There is a need for reliable markers that reflect the pathological mechanisms that underlie exacerbation severity and that can be used as a surrogate to assess treatment effects in clinical studies. Little is known as to how existing study variables and suggested markers change in both the stable and exacerbation phases of COPD. In an attempt to find the best surrogates for exacerbations, we have reviewed the literature to identify which of these markers change in a consistent manner with the severity of the exacerbation event. METHODS: We have searched standard databases between 1966 to July 2004 using major keywords and terms. Studies that provided demographics, spirometry, potential markers, and clear eligibility criteria were included in this study. Central tendencies and dispersions for all the variables and markers reported and collected by us were first tabulated according to sample size and ATS/ERS 2004 Exacerbation Severity Levels I to III criteria. Due to the possible similarity of patients in Levels II and III, the data was also redefined into categories of exacerbations, namely out-patient (Level I) and in-patient (Levels II & III combined). For both approaches, we performed a fixed effect meta-analysis on each of the reported variables. RESULTS: We included a total of 268 studies reported between 1979 to July 2004. These studies investigated 142,407 patients with COPD. Arterial carbon dioxide tension and breathing rate were statistically different between all levels of exacerbation severity and between in out- and in-patient settings. Most other measures showed weak relationships with either level or setting, or they had insufficient data to permit meta-analysis. CONCLUSION: Arterial carbon dioxide and breathing rate varied in a consistent manner with exacerbation severity and patient setting. Many other measures showed weak correlations that should be further explored in future longitudinal studies or assessed using suggested mathematical modelling techniques. Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by an airflow limitation and inflammation of the lower airways [1] . As the disease worsens, some patients experience 'exacerbations' of their principal symptoms of dyspnoea, cough and sputum. These exacerbations frequently result in a visit to a general practitioner's office or to a local hospital for treatment. Exacerbations occur in COPD patients at a median of three times a year with half of them being unreported [2] [3] [4] . The heterogeneity of COPD exacerbations make them difficult to define, classify and manage due to their range of symptoms, varied treatment requirements, seasonal occurrence, and ambiguous aetiology [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] .