{'fraction_non_alphanumeric': 0.021850899742930592, 'fraction_numerical': 0.0029991431019708655, 'mean_word_length': 5.379781420765028, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Accurately Diagnosing COPD: A Clinical Challenge With Important Consequences

COPD is an irreversible chronic inflammatory process in the lungs that afflicts millions of patients around the world. Although COPD is usually considered primarily an inflammatory airway obstructive process, it also encompasses pathologic changes in smaller more distal membranous airways (“floppy,” collapsing airways) and destruction of adjacent alveolar tissue (emphysema). COPD is associated with significant morbidity and mortality and is responsible for yearly health care costs in the hundreds of billions of dollars. An accurate diagnosis of COPD is essential for multiple reasons: (1) Effective therapies exist but can be costly and often have risks, so they should be utilized only where they are needed. (2) Other diagnoses with similar respiratory symptoms exist and need to be ruled in or out for proper management. (3) COPD disease management programs need accurate inclusion/exclusion criteria for maximum effectiveness. (4) Clinical trials of new therapies and outcome studies of various practice patterns need to be carefully focused only on patients with COPD. (5) Public policies aimed at COPD prevention and control need the appropriate targets to address. In this issue of RESPIRATORY CARE, Rice et al address the last reason given with a focus on an accurate COPD diagnosis to guide COPD readmission policies and penalties. Their primary concern is overdiagnosis; not surprisingly, COPD overdiagnosis is found to artificially inflate COPD readmission rates. This work, however, also brings into focus the challenges in determining a proper COPD diagnosis. The classic definition of COPD is a purely clinical diagnosis: a chronic cough with sputum production for at least 3 months per year for 2 consecutive years. Unfortunately, using only clinical criteria to diagnose COPD ignores the reality that symptoms of COPD are nonspecific and can mimic many other cardio-respiratory disorders. Moreover, in sedentary elderly individuals, COPD symptoms may simply be written off as consequences of aging along with a seemingly benign “smokers cough.” Clinician appreciation of COPD signs/symptoms may also be poor, and the disease is often ignored or misclassified in patient problem lists. A more widespread approach espoused by the Global