A clinical practice guideline update on the diagnosis and management of stable chronic obstructive pulmonary disease

摘要

We read with disappointment the first recommendation of recently published guidelines (1) on the diagnosis and management of stable chronic obstructive pulmonary disease (COPD). This recommendation states, "Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms" . In our opinion, this would be like recommending that fasting blood glucose not be measured in obese patients until angina develops. Even if spirometry does not in itself modify the underlying risk (smoking cessation) or warrant immediate treatment (use of bronchodilators), airflow limitation is a marker of premature death from all causes-in particular, heart attack and lung cancer.