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COPD: Johan Buffels, Jan Degryse, Jan Heyrman, and Marc Decramer Office Spirometry Significantly Improves Early Detection of COPD in General Practice: The DIDASCO Study Chest 2004; 125: 1394-1399 [Abstract] [Full text] [PDF]

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cough lasting for at least 2 weeks and results of office spirometry

Ben P. Ponsioen   (11 May 2004)

How do you define OLD on Spirometry?

Sundeep S Salvi   (12 August 2004)

Re: How do you define OLD on Spirometry?

Johan Buffels, Marc Decramer   (24 August 2004)

cough lasting for at least 2 weeks and results of office spirometry 11 May 2004
Ben P. Ponsioen, general practitoner Department of General Practice of ErasmusMC, University Medical Center Rotterdam, The Netherlands Send letter to journal: Re: cough lasting for at least 2 weeks and results of office spirometry b.ponsioen{at}erasmusmc.nl Ben P. Ponsioen	Office spirometry is to be encouraged in general practice in order to detect COPD. Cough might be the key-symptom of early stages of COPD. The short and simple questionnaire used by Buffels et al. included 4 different symptoms: a cough lasting for at least 2 weeks, breathing difficulty, wheezing, and nasal allergy. Cough for at least 2 weeks might indicate mild COPD, whereas difficulty with breathing indicates asthma or severe COPD and wheezing and nasal allergy are associated with asthma. The question arises wether cough taken as the only symtom on the questionnaire would affect the diagnostic value of the Questionnaire for COPD, in smokers and in non-smokers. In contrast to the doctors in the study of Buffels et al, many doctors do not really know the smoking habits of their patients.
How do you define OLD on Spirometry? 12 August 2004
Sundeep S Salvi, Pulmonologist Chest Research Foundation, India Send letter to journal: Re: How do you define OLD on Spirometry? sundeepsalvi{at}yahoo.com Sundeep S Salvi	I found the article and its content most interesting. However, if one is using Spirometry as a Gold Standard for diagnosing Obstructive Lung Disease, then the criteria for Spirometry should be uniform everywhere. Using FEV1/FVC <88.5% (males) and 89.3% (females), in my opinion, would grossly overestimate the diagnosis of OLD. Routinely, an FEV1/FVC ratio of <70% is used to diagnose COPD and FEV1/FVC <80% for asthma. Using the values which the authors have used would wrongly classify a large number of people with OLD.
Re: How do you define OLD on Spirometry? 24 August 2004
Johan Buffels, general practitioner Department of General Practice, Katholieke Universiteit Leuven, Belgium, Marc Decramer Send letter to journal: Re: Re: How do you define OLD on Spirometry? johan.buffels{at}coditel.net Johan Buffels, et al.	Setting a cut-off value for normal lung function values is always a matter of convention. The Didasco study was performed just before the GOLD guidelines were published. The criteria we used to define Obstructive Lung Disease were those of the ERS (Siafakas et al., Eur Respir J 1995). In these guidelines, the definition OLD was expressed as a maximum percentage of the PREDICTED values for FEV1/FVC, instead of the simple FEV1/FVC ratio. We strongly disagree with Dr. Salvi that these cut-off values would overestimate the diagnosis of OLD. To the contrary: compared to the GOLD criteria, the ERS values will rule in a smaller number of diagnoses of OLD, taking into account a correction for age and length. However, for reasons of harmonisation we agree that all future studies should use the actual conventions.