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Correspondence |

Association Between Baseline Airflow Obstruction and Rate of Decline in Lung FunctionLung Function Decline in COPD FREE TO VIEW

Deepak Aggarwal, MD; Prasanta Raghab Mohapatra, MD; Robin Gupta, MBBS
Author and Funding Information

From the Department of Pulmonary Medicine, Government Medical College & Hospital.

Correspondence to: Deepak Aggarwal, MD, Department of Pulmonary Medicine, Block-D, Level-5, Government Medical College & Hospital, Sec-32, Chandigarh. Pin: 160030, India; e-mail: drdeepak@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1694. doi:10.1378/chest.12-1725
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To the Editor:

We read with interest the study by Mohamed Hoesein et al1 (see page 1530), in which they nicely proved that rate of lung function decline is maximum in male heavy smokers with mild or no airflow limitation as documented on spirometry. However, the criteria for categorizing all enrolled patients into COPD have not been specified. In view of the lack of spirometric evidence of airway obstruction and reversibility, it is plausible that some of the subjects may actually be suffering from other airway diseases, notably asthma, which usually do not result in progressive lung function decline. Segregation of such patients by serially testing with spirometry any time during the course of 3 years could have increased the specificity of the study. Moreover, COPD is also known to occur in nonsmokers, predisposed by other risk factors like air pollution,2 genetic predisposition,3 and so forth. Inclusion of nonsmokers might have given a better picture of the association between rate of decline in lung function and stage of COPD.

Acute exacerbations of COPD also have a deleterious effect on lung functions, irrespective of stage. These, along with the COPD treatment, have been shown to alter the rate of decline in expiratory flow rates.4,5 It would be useful for readers if the authors could shed light on the clinical course of subjects, such as exacerbation frequency and treatment given during the study period. Both of these confounding factors, if not considered, might have affected the results.

COPD is a progressive disease with significant morbidity and mortality. Pending discussion, the results of this study carry huge clinical implications, emphasizing the need to devise new ways to efficiently diagnose and target patients at risk for and with early COPD.

References

Mohamed Hoesein FAA, Zanen P, Boezen HM, et al. Lung function decline in male heavy smokers relates to baseline airflow obstruction severity. Chest. 2012;142(6):1530-1538.
 
Liu Y, Lee K, Perez-Padilla R, Hudson NL, Mannino DM. Outdoor and indoor air pollution and COPD-related diseases in high- and low-income countries. Int J Tuberc Lung Dis. 2008;12(2):115-127. [PubMed]
 
Molfino NA. Genetic predisposition to accelerated decline of lung function in COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(2):117-119. [PubMed]
 
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847-852. [CrossRef] [PubMed]
 
Celli BR, Thomas NE, Anderson JA, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008;178(4):332-338. [CrossRef] [PubMed]
 

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References

Mohamed Hoesein FAA, Zanen P, Boezen HM, et al. Lung function decline in male heavy smokers relates to baseline airflow obstruction severity. Chest. 2012;142(6):1530-1538.
 
Liu Y, Lee K, Perez-Padilla R, Hudson NL, Mannino DM. Outdoor and indoor air pollution and COPD-related diseases in high- and low-income countries. Int J Tuberc Lung Dis. 2008;12(2):115-127. [PubMed]
 
Molfino NA. Genetic predisposition to accelerated decline of lung function in COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(2):117-119. [PubMed]
 
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847-852. [CrossRef] [PubMed]
 
Celli BR, Thomas NE, Anderson JA, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008;178(4):332-338. [CrossRef] [PubMed]
 
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