Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionContact Us   |  Subscribe   |  Advertise   |  Login  Page layout
Wide layoutNarrow layoutFull screen layout
Lung India Official publication of Indian Chest Society  
  Users Online: 387   Home Print this page  Email this page Small font size Default font size Increase font size


 
  Table of Contents    
LETTER TO EDITOR
Year : 2018  |  Volume : 35  |  Issue : 6  |  Page : 541-543  

Reply to: Asthma-chronic obstructive pulmonary disease overlap syndrome: Is prediction feasible?


Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Date of Web Publication30-Oct-2018

Correspondence Address:
Dr. Irfan Ismail Ayub
Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_189_18

Rights and Permissions

How to cite this article:
Ayub II, Arshad AM, Sekar P, Manimaran N, Thangaswamy D, Chockalingam C. Reply to: Asthma-chronic obstructive pulmonary disease overlap syndrome: Is prediction feasible?. Lung India 2018;35:541-3

How to cite this URL:
Ayub II, Arshad AM, Sekar P, Manimaran N, Thangaswamy D, Chockalingam C. Reply to: Asthma-chronic obstructive pulmonary disease overlap syndrome: Is prediction feasible?. Lung India [serial online] 2018 [cited 2018 Dec 16];35:541-3. Available from: http://www.lungindia.com/text.asp?2018/35/6/541/244493



Sir,

We read the letter “asthma-COPD overlap syndrome: Is prediction feasible?”[1] with keen interest and thank the authors for raising certain very pertinent issues with regard to our paper.[2]

We agree that the diagnostic criteria for asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), or as it is simply referred to as asthma-COPD overlap (ACO), in our study group were limited to a single criteria: significant bronchodilator reversibility (change in postbronchodilator forced expiratory volume in 1 s [FEV1] or forced vital capacity [FVC] by 12% and 200 ml) in the background of persistent postbronchodilator airflow limitation (FEV1/FVC <70%). We have also mentioned that more exhaustive criteria have been used by other studies in the opening paragraph of the discussion in our paper. We agree that this is a limitation in our study, as discussed in the closing paragraph of our discussion. However, we would like to bring to attention to the authors on our concluding statement in our discussion: in spite of a single diagnostic criteria being applied to identify the ACOS group in our study population, we found that features attributed to the ACOS group in our study population have been identified to be similar to those identified in patients diagnosed with ACOS with more exhaustive diagnostic criteria in other studies. Whether a single diagnostic criterion alone can suffice to identify this group of patients probably requires further research.

Second, the authors have identified that in [Table 1], there is a record of postbronchodilator drop (or minus values) in spirometric indices in some patients in the non-ACOS group in the percentage reversibility (up to −22%) and volume reversibility (up to −270 ml). The ATS/ERS Task Force on standardization of lung function testing published in 2005 has summarized that inter-maneuver variability of up to 150 ml is accepted in FVC and FEV1, and values greater than that may be due to incomplete inhalations before the FVC maneuver.[3] In these patients of our study group, up to a maximum of eight maneuvers were attempted, and hence, we had to take the best three maneuver recordings in spite of not completely meeting the acceptability criteria of inter-maneuver variability.
Table 1: Distribution of study population with respect to ankle edema

Click here to view


Third, the authors have brought to notice on the nonreproducibility of results with respect to the findings on ankle edema and number of ER visits. We used STATA statistical analysis software (Manufacturer StataCorp) and calculated significance with Pearson's Chi-square test for ankle edema [Table 1] and [Table 2] and number of ER visits [Table 3] and [Table 4] as shown in the tables which have been reproduced from our STATA output file.
Table 2: Statistical analysis output data with respect to ankle edema

Click here to view
Table 3: Distribution of study population with respect to ER visits

Click here to view
Table 4: Statistical analysis output data with respect to ER visits

Click here to view


As it can be seen from the [Table 1], [Table 2], [Table 3], [Table 4], we did find significance in both the parameters.

We once again would like to thank the authors for their interest in our paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Karim HM, Esquinas AM. Asthma-chronic obstructive pulmonary disease overlap syndrome: Is prediction feasible? Lung India 2018;35:540-41.  Back to cited text no. 1
  [Full text]  
2.
Ayub II, Arshad AM, Sekar P, Manimaran N, Thangaswamy D, Chockalingam C, et al. Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India. Lung India 2018;35:137-42.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J 2005;26:153-61.  Back to cited text no. 3
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Tables

 Article Access Statistics
    Viewed129    
    Printed3    
    Emailed0    
    PDF Downloaded44    
    Comments [Add]    

Recommend this journal