Chronic obstructive pulmonary disease and other stories . . .

Seen from the outside, general practice is a mass of lost opportunities. Never a week goes by without a paper that blames GPs for not detecting enough of the authors’ favourite condition, be it fibromyalgia, domestic violence, restless legs, prediabetes, or a hundred other maladies. An article in Lancet Respiratory Medicine (2014, doi:10.1016/S2213-2600(14)70008-6) uses the Clinical Practice Research Database to castigate primary care doctors struggling with a winter workload of respiratory infections for failing to diagnose enough early chronic obstructive airways disease. The authors claim that 85% of patients who end up with a diagnosis of chronic obstructive pulmonary disease could have been spotted earlier because of recurrent lower respiratory infections and comorbidities. Minerva wonders what good that might have achieved, other than a few words of smoking cessation advice, which the GP probably gave anyway.

In fact, the condition we lump as “chronic obstructive pulmonary disease (COPD)” is extremely variable, and most treatments are based on small effects on endpoints such as rate of exacerbations or …