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Editorials |

Outcome Measurements in COPD: Are We Schizophrenic?

Nicholas J. Gross
Author and Funding Information

Affiliations: Chicago IL
 ,  Dr. Gross is Professor Emeritus, Department of Medicine, Stritch School of Medicine, Loyola University of Chicago, and Staff Physician, Hines VA Hospital.

Correspondence to: Nicholas J. Gross, MD, PhD, PO Box 1485, Hines, IL 60141; e-mail: Nicholas.gross@med.va.gov



Chest. 2003;123(5):1325-1327. doi:10.1378/chest.123.5.1325
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Extract

Many lessons can be drawn from the article by Tashkin and Kesten in this issue of CHEST (see page 1441), but I will limit myself to just two. The first is that, yet again, it has been shown that patients with COPD do not have “irreversible” airways obstruction although many medical textbooks and even some guidelines continue to propagate this myth many years after it was shown to be untrue, as I argued in an editorial of 1986.1 What is true is that the bronchodilation that patients with COPD are capable of is less than that of asthmatics, on average. But the overlap in bronchodilator responsiveness between the two groups is so considerable that it is not possible to differentiate between them on this basis.2 When, as in the two studies they report on, a bronchodilator as potent as tiotropium is used in a typical COPD population (subjects were not selected on the basis of their prior response to a bronchodilator), the mean improvement in FEV1 can be as high as 25% over baseline, or roughly 250 mL (derived from Table 1 of the article by Taskin and Kesten). Moreover, half the patients in these studies, the “responder” group, obtained a mean FEV1 improvement of 400 mL. These are not small amounts; they compare quite favorably with those obtained by lung volume reduction surgery.3

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