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Letters Diagnosing chronic obstructive pulmonary disease

Arbitrary thresholds of natural variability and severity should not be used to diagnose chronic obstructive pulmonary disease

BMJ 2016; 352 doi: (Published 28 January 2016) Cite this as: BMJ 2016;352:i393
  1. Vito Brusasco, professor of respiratory medicine1,
  2. Riccardo Pellegrino, professor2,
  3. Martin R Miller, professor3
  1. 1Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Genoa, Italy
  2. 2Centro Medico Pneumologico Torino, Turin, Italy
  3. 3Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
  1. vito.brusasco{at}

We appreciate Conway and colleagues’ efforts to simplify the clinical approach to chronic obstructive pulmonary disease (COPD),1 but we think that this approach is not appropriate for the diagnosis of COPD in primary care. The authors suggest using the FEV1/FVC (forced expiratory volume in one second/forced vital capacity) ratio <0.70 to confirm the diagnosis of COPD,2 even though this has been hotly debated since it was first proposed by the GOLD (Global Initiative for Chronic …

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