Doubtful association
It has been said that there is no a definite correlation between the spirometric standard FEV1 and the clinical manifestations in COPD. The FEV1 may be extremely low but the patient may be doing well. So where is the real assessment of the condition? Why COPD seems to be a big puzzle for doctors and patients?
Smoking and a show of symptoms
A long time ago smoking has been linked to development of serious health conditions. Symptoms have been associated with the smoking behavior but some say that it may not be any disease.
What is normal?
This is the most enigmatic perspective about a disease: symptoms being considered normal when we all know that smoking is not normal, coughing frequently with or without sputum is not normal, a development of exaggerated breathlessness with less extenuating efforts is not normal.
Some Learning
This is what teaches us that some times (if not every time) it is better to hear the patient, to assess them from a more clinical (humanitarian) perspective than relying in para-clinical procedures. Making diagnosis only based on technical methods may bring huge disastrous consequences. Particularly when it is expected to find changes in numbers more than in the body that can be assessed with appropriate developed strong skills. When it may be easy to evaluate a patient more physically than going into an algorhythm that may simplify the “clinical” decision making process but waiting for cold results.
What to do to start?
Smoking cessation is fundamental based on clinical scientific data but we also know that symptoms associated to the continuous irritation of the airway don’t go away after smoking cessation.
Looking at the patient beyond the tech
Given these two considerations (smoking related symptoms and their persistence) we should look at the COPD patient as a real patient. It seems to be disregarding from the medical side that there is an abnormal condition due to COPD and maybe FEV1 will not be the best or definitive assessment to follow the disease up.
How to look at a COPD patient
Patients need to be considered more than a scientific set of individuals, a population to be seen from a statistical standpoint. Patients need to be seen individually and treated according to what has been shown in clinical trials but adjusted to the individual clinical reality.
History to be written
So… it is still required to look for a more clear and fair standard to monitor smoking and its effects. I hope that beyond FEV1 physicians are starting to take into account the sufferer.
