Diagnosis of COPD.

Shahab et al recently reported significant under-diagnosis of chronic obstructive pulmonary disease (COPD) in England.1 Adults over 35 years were regarded as having airway obstruction (COPD) if the forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio was <0.70. This conforms with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines2 adopted by various organisations, albeit that no data were obtained after bronchodilation. Even the GOLD group acknowledges that there is no evidence that this cut-off point signifies clinically validated airway obstruction and that “the use of this fixed ratio may result in over-diagnosis of COPD in the elderly, especially of mild disease. Using the lower limit of normal (LLN) values for FEV1/FVC that are based on the normal distribution and classify the bottom 5% of the healthy population as abnormal is one way to minimize the potential misclassification.”2 This statement does justice to science and to authors of predicted values for spirometric indices who carefully defined the LLN for various indices, none …

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