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• W2088329723 abstract "The analogy between diagnosing hypertension and COPD is seriously flawed: 140/90 is not a ratio. Either high systolic BP or high diastolic BP increases the risk of death. Hypertension is a modifiable risk factor, not a disease like COPD. Thresholds for defining and treating high BP have always been based on increased risk of cardiovascular events and death.1Lewington S Clarke R Qizilbash N Peto R Collins R Prospective Studies Collaboration Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.Lancet. 2002; 360: 1903-1913Abstract Full Text Full Text PDF PubMed Scopus (7519) Google ScholarBlood glucose, BP, hemoglobin, electrolyte concentrations, and many other physiologic variables are controlled by multiple feedback mechanisms; therefore, normal values for these tests in healthy people change little with aging. This is not true for lung function or the elasticity, reserve, and resilience of many other tissues and organ systems. Only two things in life remain certain: physiologic aging leading to death and taxes.The success of national and international programs to reduce hypertension-related morbidity and mortality was due to the excellent efficacy and low rates of serious side effects of inexpensive treatments, not agreement on a simple definition of high BP. Tens of thousands of deaths have been avoided by antihypertensive therapy each year, and the number of treatments needed to treat to prevent serious morbidity or death is relatively small.2Neal B MacMahon S Chapman N Effects of ACE inhibitors, calcium antagonists, and other blood pressure lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration.Lancet. 2000; 356: 1955-1964Abstract Full Text Full Text PDF PubMed Scopus (1608) Google Scholar This is not true for any COPD inhalers, especially when prescribed for patients with an FEV1 in the 65% to 95% predicted range. Airway obstruction in this mild range is not clinically important because morbidity is very low. In this mild range, reported dyspnea is usually not due to COPD, and exacerbations that cause a hospitalization are very rare.3de Marco R Accordini S Anto JM et al.Long-term outcomes in mild/moderate chronic obstructive pulmonary disease in the European Community Respiratory Health Survey.Am J Respir Crit Care Med. 2009; 180: 956-963Crossref PubMed Scopus (46) Google ScholarFigure 1 from Celli and Halbert4Celli BR Halbert RJ Point: should we abandon FEV1/FVC <0.70 to detect airway obstruction? No.Chest. 2010; 138: 1037-1040Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar only shows that use of the faulty fixed ratio advocated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines leads to a very high false-positive rate of diagnoses of COPD in older people. The true prevalence of clinically important COPD (as with most chronic diseases) does increase with aging, but the prevalence in smokers >70 years of age in most developed countries is <20% (not 50%).5Vollmer WM Gíslason T Burney P et al.Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study.Eur Respir J. 2009; 34: 588-597Crossref PubMed Scopus (197) Google ScholarWe believe that health-care professionals should make decisions based on evidence of improved health for individual patients and not for the benefit of disease awareness, advocacy, or policy making. We join a large group of pulmonary specialists who call on the GOLD executive committee to examine the evidence and abandon the faulty fixed ratio.6Quanjer PH Enright PL Ruppel G et al.The need to change the method for defining mild airway obstruction.Prim Care Respir J. 2010; 19: 288-291Crossref PubMed Scopus (18) Google Scholar The analogy between diagnosing hypertension and COPD is seriously flawed: 140/90 is not a ratio. Either high systolic BP or high diastolic BP increases the risk of death. Hypertension is a modifiable risk factor, not a disease like COPD. Thresholds for defining and treating high BP have always been based on increased risk of cardiovascular events and death.1Lewington S Clarke R Qizilbash N Peto R Collins R Prospective Studies Collaboration Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.Lancet. 2002; 360: 1903-1913Abstract Full Text Full Text PDF PubMed Scopus (7519) Google Scholar Blood glucose, BP, hemoglobin, electrolyte concentrations, and many other physiologic variables are controlled by multiple feedback mechanisms; therefore, normal values for these tests in healthy people change little with aging. This is not true for lung function or the elasticity, reserve, and resilience of many other tissues and organ systems. Only two things in life remain certain: physiologic aging leading to death and taxes. The success of national and international programs to reduce hypertension-related morbidity and mortality was due to the excellent efficacy and low rates of serious side effects of inexpensive treatments, not agreement on a simple definition of high BP. Tens of thousands of deaths have been avoided by antihypertensive therapy each year, and the number of treatments needed to treat to prevent serious morbidity or death is relatively small.2Neal B MacMahon S Chapman N Effects of ACE inhibitors, calcium antagonists, and other blood pressure lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration.Lancet. 2000; 356: 1955-1964Abstract Full Text Full Text PDF PubMed Scopus (1608) Google Scholar This is not true for any COPD inhalers, especially when prescribed for patients with an FEV1 in the 65% to 95% predicted range. Airway obstruction in this mild range is not clinically important because morbidity is very low. In this mild range, reported dyspnea is usually not due to COPD, and exacerbations that cause a hospitalization are very rare.3de Marco R Accordini S Anto JM et al.Long-term outcomes in mild/moderate chronic obstructive pulmonary disease in the European Community Respiratory Health Survey.Am J Respir Crit Care Med. 2009; 180: 956-963Crossref PubMed Scopus (46) Google Scholar Figure 1 from Celli and Halbert4Celli BR Halbert RJ Point: should we abandon FEV1/FVC <0.70 to detect airway obstruction? No.Chest. 2010; 138: 1037-1040Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar only shows that use of the faulty fixed ratio advocated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines leads to a very high false-positive rate of diagnoses of COPD in older people. The true prevalence of clinically important COPD (as with most chronic diseases) does increase with aging, but the prevalence in smokers >70 years of age in most developed countries is <20% (not 50%).5Vollmer WM Gíslason T Burney P et al.Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study.Eur Respir J. 2009; 34: 588-597Crossref PubMed Scopus (197) Google Scholar We believe that health-care professionals should make decisions based on evidence of improved health for individual patients and not for the benefit of disease awareness, advocacy, or policy making. We join a large group of pulmonary specialists who call on the GOLD executive committee to examine the evidence and abandon the faulty fixed ratio.6Quanjer PH Enright PL Ruppel G et al.The need to change the method for defining mild airway obstruction.Prim Care Respir J. 2010; 19: 288-291Crossref PubMed Scopus (18) Google Scholar" @default.
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• W2088329723 title "Rebuttal from Drs Enright and Brusasco" @default.
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