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Editorials: POINT/COUNTERPOINT EDITORIALS |

Rebuttal from Drs Enright and Brusasco

Paul Enright, MD; Vito Brusasco, MD
Author and Funding Information

From the University of Arizona (Dr Enright); and the Department of Internal Medicine, University of Genoa (Dr Brusasco).

Correspondence to: Paul Enright, 4460 Ina Rd, Tucson, AZ 85718; e-mail: lungguy@aol.com


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Enright and his wife were generously entertained by Boehringer Ingelheim Pharmaceuticals, Inc. twice per year at four-star resorts, including a weekend at Euro-Disney for the first Global Initiative for Chronic Obstructive Lung Disease COPD guidelines promotional meeting. He was trained in developing persuasive presentations and effective public speaking as a member of the Boehringer speakers’ bureau of key opinion leaders. He has received six-figure consulting fees from Schering and from Pfizer for reviewing the quality of spirometry tests done for a study of mometasone for COPD and varenicline for smoking cessation in patients with COPD. He was provided with the services of medical writers and editors and has been generously reimbursed by continuing medical education corporations and professional societies for developing booklets, documents, presentations, webinars, and hands-on workshops promoting the use of spirometry by primary care providers for the detection of COPD and asthma. The financial sponsors of these programs included Glaxo, AstraZeneca, Pfizer, and Novartis, all of whom make or market inhalers for COPD. His travel expenses for advisory board meetings and international professional society meetings have been reimbursed by the COPD Foundation and the National Lung Health Education Program, both of which promote office spirometry for the detection of COPD and are generously funded by pharmaceutical companies that make COPD inhalers. His travel expenses and registration fees were paid by the Federation International Respiratory Societies to Asia Pacific Society of Respirology meetings in Hong Kong, Beijing, Guangzhou, and Kyoto to serve on the writing group of recommendations for spirometry for the detection of COPD in developing countries. Dr Brusasco received funds from Lofarma for consultancies in 2008, speaking fees at conferences sponsored by Boehringer Ingelheim in 2008, fees from GlaxoSmithKline for speaking at a conference in 2010, fees from Beohringer Ingelheim for consultancy in 2009, fees from Deep Breeze for consultancy in 2009, fees from Dompé for consultancy in 2009, fees in 2008 from GlaxoSmithKline for participating in advisory boards, fees in 2007 from Almirall for serving in an advisory board, fees from Menarini for consultancy in 2008, and fees from Novartis for participating in an Advisory Board in 2010. Dr Brusasco’s institution participated in several multicenter clinical trials financed by pharmaceutical companies (Chiesi; Merck, Sharpe & Dohme; Boehringer Ingelheim; GlaxoSmithKline; Novartis).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1043-1044. doi:10.1378/chest.10-2053
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Extract

The analogy between diagnosing hypertension and COPD is seriously flawed: 140/90 is not a ratio. Either high systolic BP or high diastolic BP increases the risk of death. Hypertension is a modifiable risk factor, not a disease like COPD. Thresholds for defining and treating high BP have always been based on increased risk of cardiovascular events and death.1

Blood glucose, BP, hemoglobin, electrolyte concentrations, and many other physiologic variables are controlled by multiple feedback mechanisms; therefore, normal values for these tests in healthy people change little with aging. This is not true for lung function or the elasticity, reserve, and resilience of many other tissues and organ systems. Only two things in life remain certain: physiologic aging leading to death and taxes.

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