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Asthma shouldn't be separate from COPD

While I agree that reversibility is not necessarily needed to diagnose COPD, it most certainly is in the case of asthma (News, March 15).

Patients do not present to their GPs with a ready-made diagnosis of asthma or COPD, they consult with symptoms like cough, wheeze and shortness of breath, all of which could be due to asthma or COPD.

Unfortunately, the separate data requirements for the quality framework for COPD and asthma have led to confusion.

It may have been better to approach the two diseases together as a 'respiratory entity' and allow for data recording which would differentiate the two diseases ­ for example, recording respiratory symptoms, lung function, and then a diagnosis.

Chronic monitoring could also be approached in this way, with records for lung function, inhaler technique, self-management plans and so on.

In this way, real diagnostic and monitoring quality could have been assured. In my opinion GPs should continue to do reversibility testing, on the basis that the NICE guidelines have only provided grade 'D' evidence for their statements, which according to your article should lead to a change in the regulations.

Dr Mark Levy

Harrow, Middlesex

Alberti contradicts his own advice

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