Article Text

Download PDFPDF

Exacerbations in non-COPD patients: truth or myth
  1. Deepak Aggarwal1,
  2. Alkesh Kumar Khurana2
  1. 1 Department of Pulmonary Medicine, Government Medical College & Hospital, Chandigarh, India
  2. 2 Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
  1. Correspondence to Dr Alkesh Kumar Khurana, Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh 462024, India; lungcancer{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

We read with great interest the article by Tan et al,1 whereby they have discussed the occurrence of exacerbation-like events in patients without COPD. The basic concept of the study needs debate and clarification.

The authors have used the terms ‘non-COPD patients’ and ‘exacerbation like event’ to mention the group of patients who didn't fulfil the spirometric criteria for COPD. Without mentioning its causes, this non-COPD group with chronic respiratory symptoms seems to be a new disease process. Here, it should be clarified that this non-COPD group is not a distinct aetiological entity. Rather, these chronic symptoms are the result of any of the undetected upper and lower respiratory tract diseases, like bronchitis, bronchiectasis, postnasal drip, chronic pharyngitis, chronic cough due to Gastro-oesophageal Reflux Disease (GERD), early COPD, mild asthma, heart failure, and so on, which were not properly investigated and, hence, might have become chronic.2 Also, inclusion of acute conditions, like pneumonia, pneumothorax and using the term, exacerbation, for these patients in the non-COPD group needs explanation. Without getting a broncho-provocative challenge test, it is likely that a good number of subjects in non-COPD group might actually have asthma. The significant economic and healthcare burden of this non-COPD group is hence obvious and not surprising.3 In view of diverse aetiologies in a non-COPD group, it is difficult to justify the use of the term ‘exacerbation like events’ for this varied patient group, and compare their symptom spurts with those of acute exacerbations of COPD.

These terminologies ‘non-COPD patients’ and 'exacerbation like event’ should be used with caution, as it may, inadvertently, lead to the creation of a separate disease group, creating confusion about the correct terminology. Moreover, being easy to label, these terms are prone to be misused for all non-COPD patients, without subjecting them to detailed investigations.

It would be useful if authors exclude known causes of chronic symptoms in non-COPD patients before evaluating and comparing them with COPD. Proper diagnosis and categorisation of these non-COPD patients could help in proper management, as well as may change the course of their disease.



  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • Respiratory epidemiology
    W C Tan J Bourbeau P Hernandez K R Chapman R Cowie J M FitzGerald D D Marciniuk F Maltais A S Buist D E O'Donnell D D Sin S D Aaron for the CanCOLD Collaborative Research Group Jonathon Samet Milo Puhan Qutayba Hamid James C Hogg Jean Bourbeau Wan C Tan Carole Jabet Maria Sedona Palmina Mancino Yvan Fortier Don Sin Yuexin Li Sheena Tam Joe Comeau Adrian Ng Harvey Coxson Tara Candido Jonathon Leipsic Cameron Hague Jeremy Road Andrea Benedetti Carlo Mara Mohsen Savafi Andrea Gershon Teresa To Wan C Tan Harvey Coxson Jean Bourbeau Zhi L Pei Denis Jensen Denis O’Donnell Wan C Tan Christine Lo Jeong Min Carly Moy Anna La Lau Ashleigh Sran Ebony Swanson Ying Yuan Daniel Chen Lu Zheng Tina Yang Junior Chuang Best Guo Licong Li Kendall Chan Rahmath Khanam Daria Maslennikova Sarah Cheng Catherine Peng Bryan Chiang Sarah Guo Kyrsten Payne Jean Bourbeau Palmina Mancino Maria Sedona Carmen Darauay Myriam Costa Kenneth Chapman Patricia McClean Heather Sporn Robert Cowie Ann Cowie Curtis Dumonceaux Jessica Moore Paul Hernandez Scott Fulton Maria Yorke Natalie Fiorotos Ashley Rowe Shawn Aaron Kathy Vandemheen Gay Pratt Jeevitha Srighanthan Denis O’Donnell Kathy Webb Naparat Amornputtisathaporn Kate Cheung Kate Whelan Jenny Cheng Francois Maltais Joanie Couture Luciana Garcia Pereira Marie-Josée Breton Cynthia Brouillard Darcy Marciniuk Ron Clemens Janet Baran
  • PostScript
    Wan C Tan Jean Bourbeau Shawn Aaron J Mark FitzGerald Paul Hernandez Robert Cowie Kenneth R Chapman Darcy Marciniuk Francois Maltais Sonia Buist Denis O'Donnell Don D Sin