© 2008 American Thoracic Society
A Unique Spirometric Phenotype in COPDFrom the Authors:We thank the correspondents, in commenting on the GOLD executive summary (1), for raising the important issue of the role of tuberculosis in the development of chronic airflow limitation, and how difficult it is to differentiate in developing countries between the endemic problems of tuberculosis and chronic obstructive airway disorders, such as chronic obstructive pulmonary disease (COPD) and bronchial asthma, as they may share a similar respiratory symptomatology and airflow obstruction. Dr. Jung and colleagues make several important points about the pathophysiologic consequences of tuberculosis and particularly its contributory role in producing airflow obstruction. Data from around the world now confirm this finding, including some recent studies published since the full revision of the GOLD document to which the executive summary refers. Thus, a detailed analysis of the PLATINO study in five Latin American countries (n = 5,571 participants) found a more than fourfold increase in the likelihood of airflow obstruction in middle-aged and older patients with a past history of tuberculosis, an effect that was suggested to be independent of smoking (2). Similar changes were found in a total of 5,539 Colombian residents at different altitudes, where tuberculosis was an independent risk factor for COPD, with an almost threefold increase in the odds ratio of this diagnosis being made, an association that was even higher than with cigarette smoking (3). Our comments relating to symptomatic tuberculosis as a precursor for a COPD diagnosis reflect the importance of both symptoms and impaired function in making a clinical diagnosis of COPD. However, work such as that from Korea, South America, and Cape Town (n = 335 participants), which had by far the highest prevalence of stage II or greater COPD from a total of 12 sites (n = 9,425 participants) included as part of the BOLD initiative (4), emphasizes the significant damage which tuberculosis can produce. Since smoking is itself a major risk factor for the development of tuberculosis, the interaction of these two processes merits further study.
Leiden University Medical Center
Global Initiative for Chronic Obstructive Lung Disease
Hopital Cliníc i Provincial
University Hospital Aintree On behalf of the GOLD Science Committee FOOTNOTES Conflict of Interest Statement: K.F.R. has consulted, participated in advisory board meetings, and received lecture fees from AstraZeneca, Boehringer Ingelheim, Chiesi Pharmaceuticals, Pfizer, Novartis, AltanaPharma, Merck Sharp & Dohme (MSD), and GlaxoSmith Kline (GSK); the Department of Pulmonology, and thereby K.F.R. as head of the department, has received grants from Novartis, AstraZeneca, Boehringer Ingelheim, Roche, and GSK in the years 2005 until 2008. S.H. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript. R.R.-R. has participated as a lecturer and speaker in scientific meetings and courses under the sponsorship of Almirall, Boehringer Ingelheim, Chiesi, GSK, Kyorin, Novartis, and Pfizer; he consulted with several pharmaceutical companies (Altana/Nycomed, Boehringer Ingelheim, GSK, Novartis, and Pfizer); he serves on advisory boards for Almirall, Boehringer Ingelheim, GSK, Novartis, Pfizer, and Procter & Gamble; he has been sponsored for several clinical trials by, and received laboratory research support from, Almirall, AstraZeneca, Boehringer Ingelheim, GSK, Esteve, and Pfizer. P.M.C. has received honoraria for serving on study advisory boards for GSK and Pfizer and has received funding to conduct clinical trials by GSK, Altana, and Chiesi. REFERENCES
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