Letter

Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough

BMJ 1998; 317 doi: 10.1136/bmj.317.7165.1078a (Published 17 October 1998)
Cite this as: BMJ 1998;317:1078.2

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Why was no control group studied?

  1. Joseph M Rothenberg (shirl@netvision.net.il), Primary care internist.
  1. 5 Amatzia Street, German Colony, Jerusalem, Israel
  2. Mater Misericordiae Children's Hospital, South Brisbane, QLD 4101, Australia
  3. Plompstraat 3, 3815 MV Amersfoort, Netherlands
  4. Department of Lung Diseases, Groningen University Hospital, PO Box 30001, 9700 RB Groningen, Netherlands

    EDITOR —Thiadens et al examined 192 patients presenting to their general practitioner with persistent cough —a common and challenging problem in primary care —and found a high prevalence of asthma (39%) and chronic obstructive pulmonary disease (7%).1 I was disappointed that they did not provide a control group of asymptomatic subjects in the community.

    What is the prevalence of abnormal results of pulmonary function tests in their general population? If it is high, with a prevalence approaching the prevalence found in their population of patients with cough, an alternative conclusion might be that asthma and chronic obstructive pulmonary disease are common and not significantly more common in the population of patients with cough. I encourage Thiadens et al to examine their study group further. One issue deserving scrutiny is whether these patients are still coughing after six months. Also, what diagnoses (if any) apply to the remaining (54%) patients with cough, and does their prognosis differ from that of the group diagnosed as having asthma and chronic obstructive pulmonary disease? Finally, how do these patients respond to different treatments?

    References

    1. ↵
      1. Thiadens HA,
      2. de Bock GH,
      3. Dekker FW,
      4. Huysman JAN,
      5. van H,
      6. ouwelingen JC,
      7. Springer MP,
      8. et al.
      Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study.BMJ1998; 316:1286–1290. (25 April.)
      OpenUrlFREE Full Text

    Children with cough alone should not be labelled asthmatic

    1. A B Chang, Consultant paediatric respiratory physician.,
    2. I B Masters, Director of respiratory medicine.
    1. 5 Amatzia Street, German Colony, Jerusalem, Israel
    2. Mater Misericordiae Children's Hospital, South Brisbane, QLD 4101, Australia
    3. Plompstraat 3, 3815 MV Amersfoort, Netherlands
    4. Department of Lung Diseases, Groningen University Hospital, PO Box 30001, 9700 RB Groningen, Netherlands

      EDITOR —Thiadens et al devised a score to estimate the probability of asthma or chronic obstructive pulmonary disease in patients who present …

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