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I fully agree with the authors in their article concerning the risk of oversimplifying COPD. Concerning the popular phenomenon of substitution of COPD care to the first line, ie the general practitioner (GP), trying to diagnose as little as possible COPD patients in the second line, even further increases the risk of over diagnosis in (older) patients with asthma. In these subjects the asthma COPD overlap syndrome (ACOS) appears to be present in as many as 16% to 30% (1). Moreover in the 'healthy smoker' (ie normal lung function with a FEV1/FVC ratio >0.70) the presence of significant emphysema has been shown to be 43% (2).
This implies a central role for the pulmonologist in diagnosing COPD. If possible the patient will thereafter be taken care of by the GP, which will be ~80% of all COPD patients, as a result of the distribution of severety of airflow obstruction and/or burden of disease.
In contrast to the general opinion, in COPD diagnosis there is more to determine than just the FEV1 and the FEV1/FVC ratio, as we as professional pulmonologists show on a daily basis.
1. Zeki AA, Schivo M, Chan A, et al. The Asthma-COPD Overlap Syndrome: a common clinical problem in the elderly. J Allergy (Cairo). 2011:2011:861926.
2. Stratelis G, Fransson S-G, Schmekel B, et al Scandinavian journal of primary health care. 2008; 26(4):241-7.
Re: Chronic obstructive pulmonary disease: missed diagnosis versus misdiagnosis
I fully agree with the authors in their article concerning the risk of oversimplifying COPD. Concerning the popular phenomenon of substitution of COPD care to the first line, ie the general practitioner (GP), trying to diagnose as little as possible COPD patients in the second line, even further increases the risk of over diagnosis in (older) patients with asthma. In these subjects the asthma COPD overlap syndrome (ACOS) appears to be present in as many as 16% to 30% (1). Moreover in the 'healthy smoker' (ie normal lung function with a FEV1/FVC ratio >0.70) the presence of significant emphysema has been shown to be 43% (2).
This implies a central role for the pulmonologist in diagnosing COPD. If possible the patient will thereafter be taken care of by the GP, which will be ~80% of all COPD patients, as a result of the distribution of severety of airflow obstruction and/or burden of disease.
In contrast to the general opinion, in COPD diagnosis there is more to determine than just the FEV1 and the FEV1/FVC ratio, as we as professional pulmonologists show on a daily basis.
1. Zeki AA, Schivo M, Chan A, et al. The Asthma-COPD Overlap Syndrome: a common clinical problem in the elderly. J Allergy (Cairo). 2011:2011:861926.
2. Stratelis G, Fransson S-G, Schmekel B, et al Scandinavian journal of primary health care. 2008; 26(4):241-7.
Competing interests: No competing interests