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Bartolome R. Celli, MD, FCCP
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From the Brigham and Women’s Hospital, Harvard Medical School.

Correspondence to: Bartolome R. Celli, MD, FCCP, Brigham and Women’s Hospital, Pulmonary and Critical Care, 75 Francis St, Boston, MA 02115; e-mail: bcelli@copdnet.org.


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Celli has received funds from GlaxoSmithKline, Boehringer Ingelheim, Pfizer Inc, AstraZeneca, Almirall, Aerys, and Esteve for participating in advisory boards and has spoken at different meetings. The division he works in has been awarded research grants for different medication trials by the same companies and for the discovery of new biomarkers in COPD. The division that Dr Celli works in has received grants for the participation in the development of biologic lung volume reduction surgery from the company AERIS.

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


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1254. doi:10.1378/chest.11-0549
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To the Editor:

I am happy that the Point/Counterpoint Editorial (November 2010)1,2 have stirred interest in the medical community regarding the use of spirometry to define COPD. In their letter, Drs Robberts and Schermer present support to both positions expressed in the Point/Counterpoint Editorials.

First, they agree that the health-care provider is the person who decides the clinical significance of an observed test result, a central argument in our thesis. In this context, a cutoff value for any test serves only as a guide, as it does for all of the supportive tests in medicine. Even though the authors of the letter would like to avoid the comparison, how would they interpret a hemoglobin value of 12.9 mg/dL in a 75-year-old man? Would they label the patient as having anemia? Or, for that matter, an arterial BP of 140/90 mm Hg in an 82-year-old woman? In both instances, the health practitioner uses the clinical context to determine whether the test result supports (and I emphasize the word support) a clinical diagnosis. Agreed-upon operational definitions are by and large used in studies to avoid subjective misclassification. In this regard, the simpler the definition, the more likely it will be accepted and shared.

Second, the authors of the letter support the argument presented by Enright and Brusasco2 that the predictive value is better because it corrects the “overdiagnosis” in elderly subjects who would not have COPD. They base the argument on their study evaluating the value of spirometries in the diagnosis of COPD from The Netherlands.3 That work used as reference predictive lung function values obtained from the European Community for Steel and Coal.4 I ask, what about the large portions of the world where there are no predictive values for lung function? What are they to use? I believe that an agreed-upon ratio corrects for differences and provides clinicians everywhere with a practical tool for a disease that remains largely underdiagnosed. For the fourth-largest killer in the world, a simplified operational definition can go a long way in simplifying the approach to its eradication.

Celli BR, Halbert RJ. Point: should we abandon FEV1/FVC <0.70 to detect airway obstruction? No. Chest. 2010;1385:1037-1040. [CrossRef] [PubMed]
 
Enright P, Brusasco V. Counterpoint: should we abandon FEV1/FVC <0.70 to detect airway obstruction? Yes. Chest. 2010;1385:1040-1042. [CrossRef] [PubMed]
 
Schermer TR, Smeele IJ, Thoonen BP, et al. Current clinical guideline definitions of airflow obstruction and COPD overdiagnosis in primary care. Eur Respir J. 2008;324:945-952. [CrossRef] [PubMed]
 
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;616:5-40
 

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References

Celli BR, Halbert RJ. Point: should we abandon FEV1/FVC <0.70 to detect airway obstruction? No. Chest. 2010;1385:1037-1040. [CrossRef] [PubMed]
 
Enright P, Brusasco V. Counterpoint: should we abandon FEV1/FVC <0.70 to detect airway obstruction? Yes. Chest. 2010;1385:1040-1042. [CrossRef] [PubMed]
 
Schermer TR, Smeele IJ, Thoonen BP, et al. Current clinical guideline definitions of airflow obstruction and COPD overdiagnosis in primary care. Eur Respir J. 2008;324:945-952. [CrossRef] [PubMed]
 
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;616:5-40
 
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