BMJ  2007;335:1225 (15 December), doi:10.1136/bmj.39423.433704.1F

Letters

Prognostic pessimism

Don’t group COPD and asthma

The first 150 words of the full text of this article appear below.

We have concerns about the CAOS study’s interpretation of prognostic estimates by grouping chronic obstructive pulmonary disease (COPD) and asthma together1: this may underestimate the true discrepancy suggested.

Asthma and COPD are essentially different diseases, in terms of aetiology, clinical course of exacerbations, and responses to critical care interventions—for example, ventilatory management. Furthermore, the inhospital death rates for intubated patients are notably different, at 20-30% for COPD2 3 and about 10% for asthma.4

Both diseases have differing prognostic indicators of outcomes, which may have an important influence on intensive care clinicians’ judgments on whether to admit such patients.

We believe that patients with severe asthma are much less likely to be refused admission to intensive care or intubation than patients with severe exacerbations of COPD. Furthermore, perceptions of out of hospital survival for asthma are likely to be better than for COPD. We therefore speculate that the difference between predicted . . . [Full text of this article]

Suveer Singh, consultant in intensive care and respiratory medicine1, Daffyd Lloyd, anaesthesia resident1, Tasneem Katawala, anaesthesia resident1, James Harris, anaesthesia resident1, Radha Sabharatnam, foundation year 11

1 Intensive Care Unit, Magill Department of Anaesthesia, Intensive Care, and Pain Management, Chelsea and Westminster Hospital, London SW10 9HJ

suveer.singh@imperial.ac.uk


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Relevant Article

Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study
Martin J Wildman, Colin Sanderson, Jayne Groves, Barnaby C Reeves, Jon Ayres, David Harrison, Duncan Young, and Kathy Rowan
BMJ 2007 335: 1132. [Abstract] [Full Text] [PDF]

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