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Chronic obstructive pulmonary disease in the veterans affairs hospitals: haven't we seen this before?
| Content Provider | Semantic Scholar |
|---|---|
| Copyright Year | 2010 |
| Abstract | In radiology, the term “Aunt Minnie” has been used for decades. Attributed to Dr Benjamin Felson, it refers to “a case with radiologic findings so specific and compelling that no realistic differential diagnosis exists.” In Dr Felson’s mind, if it looks like your Aunt Minnie, then it must be Aunt Minnie.1 To paraphrase Dr Felson, patients with chronic obstructive pulmonary disease (COPD) often fall into the Aunt Minnie category. If it looks like COPD, then in must be COPD. There are undoubtedly providers who make the diagnosis of COPD on a clinical basis. COPD often harkens images of patients labeled as “pink puffers” or “blue bloaters,” patients with severe emphysema or progressive cor pulmonale. Unfortunately, while these do represent COPD patients, the disease severity represented is often end-stage and in inexorable decline. COPD has long been acknowledged as a major cause of respiratory disability, but the magnitude of its impact has been only recently recognized. It is the fourth leading cause of death in the United States and is the only cause of death projected to continue to increase over the ensuing decade.2,3 The American Thoracic Society and European Respiratory Society joint COPD guidelines emphasize COPD as a preventable and treatable disease, much different from previous images of end-stage lung disease.4 The Global Initiative for Chronic Obstructive Lung Disease further emphasizes an extrathoracic systemic component that previously attracted little attention.5 The diagnosis of COPD should be considered in any patient who experiences cough, sputum production, or dyspnea, in association with specific risk factors, which for the vast majority is cigarette smoking. Spirometry is essential for diagnosis and to categorize the severity of disease. The recommendation for spirometry is reiterated in numerous treatment guidelines, including one from the Veterans Affairs Healthcare System and Department of Defense.6,7 It would seem that diagnosis would be straightforward, but experience suggests that this is not the case. The shortcomings in COPD diagnosis by the medical community are well documented. Some databases in England would place the COPD prevalence at 1.4%, when it is closer to 20%, with estimates as high as 65% not diagnosed because symptoms are misinterpreted.8 Other reviews suggest a worldwide prevalence closer to 10% in adults over 40 years of age.9-11 Irrespective of the actual prevalence, it is clearly not 2%, as this would be inconceivable for a condition projected to be the third leading worldwide cause of death by 2020. Without a diagnosis, treatment cannot be rendered and COPD morbidity and mortality will continue to increase. |
| File Format | PDF HTM / HTML |
| PubMed reference number | 20420739 |
| Journal | Medline |
| Volume Number | 55 |
| Issue Number | 5 |
| Alternate Webpage(s) | http://www.rcjournal.com/contents/05.10/05.10.0643.pdf |
| Alternate Webpage(s) | http://rc.rcjournal.com/content/respcare/55/5/643.full.pdf |
| Journal | Respiratory care |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
