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its clinical impact and its prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Consequently&#44; the EPI-SCAN II leaves out information not only from the so-called &#8220;empty Spain&#8221; but also from populated rural areas&#46; The use of phone numbers by postal code might also exclude a population that does not have a landline number&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Secondly&#44; in an epidemiological study of prevalence&#44; the definition of a case is crucial&#46; In the EPI-SCAN II study&#44; the cases are not identified as COPD patients&#44; but are based solely on the identification of bronchial obstruction in post-bronchodilator spirometry&#46; However&#44; the diagnosis of COPD is not based solely on this functional finding&#46; Currently&#44; 3 diagnostic criteria are needed&#58; previous exposure&#44; respiratory symptoms&#44; and bronchial obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; according to EPI-SCAN II results&#44; 27&#37; had never smoked and report no other exposure except for some cases of electronic cigarettes&#46; Moreover&#44; the recorded symptom rate of less than 50&#37; and the CAT questionnaire score of 9&#46;07 points in patients with COPD suggest that many cases identified as COPD were in fact asymptomatic&#46; All of this suggests that the authors are evaluating the prevalence not of COPD&#44; but rather of airflow obstruction&#46; Only in the headings of some of the tables and figures do the authors recognize that they are not evaluating the prevalence or underdiagnosis of COPD&#44; but airflow obstruction&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The confusion between COPD and chronic airflow obstruction has been exacerbated for years by epidemiological studies that have equated bronchial obstruction with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; bronchial obstruction is a functional finding associated with numerous airway diseases&#44; and should not be synonymous with COPD&#46; The EPI-SCAN II study itself states that 16&#46;9&#37; of these &#8220;COPD&#8221; cases had a diagnosis of bronchial asthma&#46; As pulmonologists we believe it is important to place value on the correct diagnosis of diseases in our specialty&#44; in order to avoid propagating confusing concepts that overestimate actual prevalence and do not help clinicians in making decisions and seeking the best treatment for their patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study has received a grant from the <span class="elsevierStyleGrantSponsor" id="gs0005">Instituto de Salud Carlos III</span>&#44; FIS Project <span class="elsevierStyleGrantNumber" refid="gs0005">PI18&#47;00682</span> included in the 2017&#8211;2020 Strategic Action on Health State Plan for Scientific and Technical Research and Innovation from the Instituto de Salud Carlos III&#44; FEDER funds&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">JLLC has received honoraria in the past 3 years for lectures&#44; scientific consultancy&#44; clinical trial participation&#44; and writing of papers for&#58; AstraZeneca&#44; Boehringer Ingelheim&#44; Chiesi&#44; CSL Behring&#44; Esteve&#44; Ferrer&#44; Gebro&#44; GlaxoSmithKline&#44; Grifols&#44; Menarini&#44; Novartis&#44; Rovi and Teva&#46; BAN declares having received honoraria in the past 3 years for speaking engagements&#44; scientific consultancy&#44; participation in clinical trials&#44; and writing of papers for&#58; AstraZeneca&#44; Boehringer Ingelheim&#44; Chiesi&#44; FAES&#44; Ferrer&#44; GlaxoSmithKline&#44; Menarini&#44; Novartis and Rovi&#46;</p></span></span>"
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Letter to the Editor
COPD diagnosis in EPI-SCAN II
El diagnóstico de la EPOC en EPI-SCAN II
José Luis Lopez-Camposa,b,
Corresponding author
lopezcampos@separ.es

Corresponding author.
, Bernardino Alcázar Navarreteb,c
a Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
c Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Granada, Spain
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its clinical impact and its prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Consequently&#44; the EPI-SCAN II leaves out information not only from the so-called &#8220;empty Spain&#8221; but also from populated rural areas&#46; The use of phone numbers by postal code might also exclude a population that does not have a landline number&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Secondly&#44; in an epidemiological study of prevalence&#44; the definition of a case is crucial&#46; In the EPI-SCAN II study&#44; the cases are not identified as COPD patients&#44; but are based solely on the identification of bronchial obstruction in post-bronchodilator spirometry&#46; However&#44; the diagnosis of COPD is not based solely on this functional finding&#46; Currently&#44; 3 diagnostic criteria are needed&#58; previous exposure&#44; respiratory symptoms&#44; and bronchial obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; according to EPI-SCAN II results&#44; 27&#37; had never smoked and report no other exposure except for some cases of electronic cigarettes&#46; Moreover&#44; the recorded symptom rate of less than 50&#37; and the CAT questionnaire score of 9&#46;07 points in patients with COPD suggest that many cases identified as COPD were in fact asymptomatic&#46; All of this suggests that the authors are evaluating the prevalence not of COPD&#44; but rather of airflow obstruction&#46; Only in the headings of some of the tables and figures do the authors recognize that they are not evaluating the prevalence or underdiagnosis of COPD&#44; but airflow obstruction&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The confusion between COPD and chronic airflow obstruction has been exacerbated for years by epidemiological studies that have equated bronchial obstruction with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; bronchial obstruction is a functional finding associated with numerous airway diseases&#44; and should not be synonymous with COPD&#46; The EPI-SCAN II study itself states that 16&#46;9&#37; of these &#8220;COPD&#8221; cases had a diagnosis of bronchial asthma&#46; As pulmonologists we believe it is important to place value on the correct diagnosis of diseases in our specialty&#44; in order to avoid propagating confusing concepts that overestimate actual prevalence and do not help clinicians in making decisions and seeking the best treatment for their patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study has received a grant from the <span class="elsevierStyleGrantSponsor" id="gs0005">Instituto de Salud Carlos III</span>&#44; FIS Project <span class="elsevierStyleGrantNumber" refid="gs0005">PI18&#47;00682</span> included in the 2017&#8211;2020 Strategic Action on Health State Plan for Scientific and Technical Research and Innovation from the Instituto de Salud Carlos III&#44; FEDER funds&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">JLLC has received honoraria in the past 3 years for lectures&#44; scientific consultancy&#44; clinical trial participation&#44; and writing of papers for&#58; AstraZeneca&#44; Boehringer Ingelheim&#44; Chiesi&#44; CSL Behring&#44; Esteve&#44; Ferrer&#44; Gebro&#44; GlaxoSmithKline&#44; Grifols&#44; Menarini&#44; Novartis&#44; Rovi and Teva&#46; BAN declares having received honoraria in the past 3 years for speaking engagements&#44; scientific consultancy&#44; participation in clinical trials&#44; and writing of papers for&#58; AstraZeneca&#44; Boehringer Ingelheim&#44; Chiesi&#44; FAES&#44; Ferrer&#44; GlaxoSmithKline&#44; Menarini&#44; Novartis and Rovi&#46;</p></span></span>"
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Article information
ISSN: 15792129
Original language: English
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