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We appreciate the detailed letter to the editor from Drs. Tenajas and Miraut and their assessments of our methods and findings. They emphasize several additional important points including the need for primary care clinicians to regularly assess their patients with COPD. This is best done using standardized instruments that allow longer term tracking and comparison of response to therapy, improvement and disease progression. Furthermore, this comment can be expanded to many other chronic diseases. Clinicians often find their gestalt of how a person is doing is not as accurate as a formal assessment.1-5 We also fully support the push for various guideline groups to work toward greater consensus so that quality improvement work is internationally relevant and generalizable. Finally, we agree with Drs. Tenajas and Miraut that the risks of inhaled corticosteroids (ICS) are often underestimated. This may be exacerbated by GOLD updates of the past several years, especially the executive summaries, which highlight the use of triple therapy for selected individuals as initial therapy. It is easy to miss the entire context concerning which individuals are candidates for this therapy.6 All efforts to improve medical therapy decision making by including considerations of both risks and benefits are to be commended.
References
1. Yawn BP, Wollan PC, Rank MA, Bertram SL, Juhn Y, Pace W. Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial. Ann Fam Med. Mar 2018;16(2):100-110. doi:10.1370/afm.2179
2. Yawn BP, Dietrich AJ, Wollan P, et al. TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management. Ann Fam Med. Jul 2012;10(4):320-9. doi:10/4/320 [pii]
10.1370/afm.1418
3. Yawn BP, Enright PL, Lemanske RF, Jr., et al. Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD. Chest. 2007 2007;132(4):1162-1168. In File.
4. Chaney EF, Rubenstein LV, Liu C-F, et al. Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign. Implementation Science. 2011/10/27 2011;6(1):121. doi:10.1186/1748-5908-6-121
5. Gruffydd-Jones K, Marsden HC, Holmes S, et al. Utility of COPD Assessment Test (CAT) in primary care consultations: a randomised controlled trial. Prim Care Respir J. Mar 2013;22(1):37-43. doi:10.4104/pcrj.2013.00001
6. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention. Accessed April 30, 2025. https://goldcopd.org/wp-content/uploads/2024/02/POCKET-GUIDE-GOLD-2024-v...