Chronic obstructive pulmonary disease

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7143.1475 (Published 16 May 1998) Cite this as: BMJ 1998;316:1475

No longer any justification for therapeutic nihilism

  1. D Robin Taylor, Senior lecturer in respiratory medicine
  1. Department of Medicine, University of Otago Medical School, Dunedin, New Zealand

    In an environment where clinicians are increasingly conscious of the conflicting pressures of patients' expectations and evidence obsessed purchasers, there is a temptation to regard guidelines as a potential straightjacket (and protocols and clinical pathways even more so)—or just irrelevant. But the recently published British Thoracic Society guidelines for managing chronic obstructive pulmonary disease should be welcomed.1

    Together with their international counterparts,24 they signal a sea change in attitudes towards the management of this common disease, historically summed up at best as “treat it as if it were asthma” and at worst as neglectful nihilism. In addition, they set out a pragmatic definition of chronic obstructive pulmonary disease—a chronic slowly progressive disorder characterised by airways obstruction which does not change markedly over several months—which ought to see the end of the paralysing effect of trying to define similarities and differences between chronic obstructive pulmonary disease and asthma (are you a lumper or a splitter?). This should …

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