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  1. Identifying asthma and...
  2. Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study
General Practice

Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7140.1286 (Published 25 April 1998) Cite this as: BMJ 1998;316:1286

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Why no control group?
EDITOR -- Thiadens, et al examined 192 patients presenting to their general practitioner with persistent cough and discovered a high prevalence of asthma (39%) and chronic obstructive pulmonary disease (7%). These researchers and the editors of the BMJ are to be congratulated on tackling a common and challenging problem in primary care practice and applying it to scientific scrutiny. Articles such as this one are what maintain the BMJ at the forefront of medical literature and information.

I was disappointed that Thiadens et al did not provide a control group for examination, i.e. asymptomatic individuals in the community. Specifically, what is the prevalence of abnormal pulmonary function tests in their general population? If it is high, with a prevalence
approaching that found in this coughing population,
an alternative conclusion might be offered: that asthma and chronic obstructive pulmonary disease are common and not significantly more so in the population of coughers.

I encourage Thiadnes, et al to pursue further examination of their study group as I am sure that much more information can be garnered here. One issue deserving scrutiny is whether these patients are still coughing after six months and thereafter? Also, what diagnoses can be rendered (if any) to the remaining (54%) of coughers and does their prognosis differ from the group diagnosed with asthma and chronic obstructive pulmonary disease? Finally, how do these patients respond to different therapies?

Competing interests: No competing interests

16 May 1998
Joseph M Rothenberg
primary care internist
Jerusalem, Israel
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