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LETTER TO EDITOR
Year : 2013  |  Volume : 30  |  Issue : 3  |  Page : 224  

Comments on editorial - Test of reversibility of airway obstruction: Time for review


Department of Pulmonary Medicine, R D Gardi Medical College, Ujjain, India

Date of Web Publication7-Aug-2013

Correspondence Address:
H G Varudkar
Department of Pulmonary Medicine, R D Gardi Medical College, Ujjain
India
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DOI: 10.4103/0970-2113.116239

PMID: 24049262

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How to cite this article:
Varudkar H G. Comments on editorial - Test of reversibility of airway obstruction: Time for review. Lung India 2013;30:224

How to cite this URL:
Varudkar H G. Comments on editorial - Test of reversibility of airway obstruction: Time for review. Lung India [serial online] 2013 [cited 2014 Sep 22];30:224. Available from: http://www.lungindia.com/text.asp?2013/30/3/224/116239

Sir,

We read with interest the editorial on testing of reversibility of airflow obstruction by Chhabra [1] and would like to offer the following comments:

  1. Why only reversibility of bronchospasm is given so much importance?

    I don't understand this particular criterion of differentiation and discussion. Any disease affecting tracheobronchial tree will be having similar manifestations. A disease producing inflammation of mucosa will be producing variable bronchospasm too. A disease producing only edema of the mucosa can produce temporary obstructive pattern. In our short research projects by medical students, we have found that even acute bronchitis can give a similar picture. Thus, basic pathology needs to be understood and evaluated rather than its spirometric observations. It would better approach to have a list of diseases producing airway obstruction and reversibility to various medications. By sticking to only these two diseases, we are limiting the scope of understanding airways diseases with wider perspectives.
  2. Why allergic element of asthma is neglected in definitions?

    It would have been worth to include this important basic pathological element somewhere in definitions or differentiations or evaluations. The management of allergy can be different. Understandably, it should start from the identification and prevention of allergens. Our climatic conditions are different from the Westerners. Their experience need not be applied to our patients in the full sense.
  3. Why not have criteria rather than definitions?

    So called chronic obstructive pulmonary disease (COPD), asthma and may be, other related diseases, at present appear to be confusing to all experts. Similar situation was with disease like rheumatoid arthritis. The authorities reached to a consensus by adopting criteria for diagnosis of those diseases. We can formulate some criteria on similar lines. This can result in a clearer picture.
  4. Why not to prepare some instrument to assess the proportions of chronic bronchitis, emphysema and asthma in a patient?

    Overlapping presentations of these basic pathologies is not only a problem in patient population, but also in a patient. If we have some instrument for assessing the severity of basic pathologies such as chronic bronchitis, emphysema and asthma, we can apply it in our day-to-day work and solve the tangle easily. We can say so and so patient has 40% element of chronic bronchitis, 40% emphysema and 20% asthma; and we will manage accordingly. This will also help in selection criteria of various researches. If any drug is effective in reducing mucus production, we can select patients with more proportion of chronic bronchitis. Thus, a research worker will include more correct population of patient for his studies. Today, the word COPD does not differentiate subtleties of heterogeneous pathologies giving rise to confusions. Needless to say that, by more selection of patients the proportions of confusing results will be less.
The author is working in a pioneer institution of India; therefore, we expect original work and research pertinent to our country, rather than following the western concepts. Therefore, I request you to consider my observations seriously and initiate work accordingly.

 
   References Top

1.Chhabra SK. Test of reversibility of airway obstruction: Time for review. Lung India 2013;30:3-4.  Back to cited text no. 1
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Chhabra SK
Lung India. 2013; 30(3): 225
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