COPD series

Issue: BCMJ, vol. 50, No. 5, June 2008, Page 242 Letters

Thank you for your recent and excellent series on COPD in the March issue of BCMJ [2008;50:78-102]. Many excellent points were raised. I am looking forward to the April issue.

Recent studies seem to “hyper-inflate” the benefit and dismiss the potential harm of long-acting inhaled bronchidilator and corticosteroid treatments. 

For instance, in the recent Advir trial, TORCH, the benefit was strongly promoted even though it was not statistically significant, yet the harm received very little discussion; the risk of dying over the 3-year study duration was not reduced (P>.052 vs placebo, and much less significant compared with either agent alone), there was not a clinically significant improvement in quality of life, and the risk of treatment-induced pneumonia was nearly doubled (19.6% vs 12.3%, P<.001, RRI 59%, ARI 7.3%, OR 1.59, NNH 14). 

There is active debate regarding the use of ß2 agonists in COPD (Canadian Family Physician, August and September 2007, pp. 1290 -1293 and pp. 1429-1430 respectively).

I am familiar with the pharmacological treatment ladder for COPD and the role for spirometry. I agree that “significant response to bronchidilator is… uncommon in COPD.” 

So I need to ask, when it is documented by spirometry that this patient has had no significant response to bronchidilator therapy and given that the literature reveals the above, why do the guidelines recommend such treatment? Are we overprescribing and doing them a disservice?

—Richard Beever, MD
Fraser Lake

Richard Beever, MD. COPD series. BCMJ, Vol. 50, No. 5, June, 2008, Page(s) 242 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply