Reversing concepts on COPD irreversibility

Common diseases are complex. The study of complexity is based on a new way of thinking that stands in sharp contrast to the philosophy underlying Newtonian science, which is based on reductionism, determinism and objective knowledge. Initially, we might aim to reduce complexity to understand nature 1. In the current issue of the European Respiratory Journal ( ERJ ), Tashkin et al. 2 report the baseline results for bronchial hyperresponsiveness in patients recruited in an ongoing, large chronic obstructive pulmonary disease (COPD) clinical trial, the Understanding the Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial 3. This report 2 challenges the vastly established concept that lung function in COPD is largely irreversible. Tashkin et al. 2 concluded that over one-half to nearly two-thirds of participating subjects met the most commonly used criteria for acute bronchodilator responsiveness, and more than one-third showed acute responsiveness by an increase in the percentage predicted criterion. Most certainly, the combined strategy employed in the UPLIFT trial involving the use of two bronchodilators (80 μg ipratropium and 400 μg salbutamol) to ensure maximum or near-maximum bronchodilation magnifies this biological finding. Currently, both American Thoracic Society/European Respiratory Society 4 and Global Initiative for Chronic Obstructive Lung Disease 5 …