Critical reading exercise
Since the topic of this paper is important in primary care, and its
methods, results and conclusions clearly presented, I thought that it
might make an interesting subject for a tutorial on critical reading with
my GP Registrar. A more than normally careful scrutiny made me realise
how much I must miss in my usual scanning of the BMJ. I would like to
raise three points (having already read previous e-responses to the
article which cover others).
1. The diagnostic criteria chosen differ from those currently
recommended by the B.T.S.; the latter do not refer to FEV1 after
bronchodilatation, and mild COPD is defined as 60-79% predicted, compared
to 85% in the article. What is the rationale behind these criteria?
2. Table 2, under FEV1 after bronchodilator refers to Predicted FEV1
at 3 months and 3 years: should this read "Mean FEV1" or have I
3. The finding that an oral steroid trial does not predict response
to an inhaled steroid not only runs counter to the current guidelines
which recommend such a trial, but surely demands more discussion than it
Finally, I share other commentators concerns at the side-effects such
as hoarseness and bruising, and the doubtful cost-benefit given the high
cost of inhaled fluticasone and the relatively minor reduction in
exacerbations on treatment.
All the same, I thank the authors for prompting me to spend an hour
in analytical mode instead of on automatic pilot!
Competing interests: No competing interests