WINSLOW ENGEL, M.D.
To the editor: The excellent study by Anthonisen and associates (1) contained much careful reasoning in the section on clinical significance. However, it is on the question of clinical significance that I would like to make a criticism or, at least, request additional information.
The authors combined several different symptoms (dyspnea, sputum volume, and purulence) in their definition of an exacerbation and the determination of treatment success or failure. Similarly, their definition of deterioration included both hospitalization and unblinded subsequent treatment with antibiotics. My concern is that, by reporting only on these multidimensional outcome measures, the true clinical significance of
ENGEL W. Antibiotic Therapy and Chronic Obstructive Pulmonary Disease. Ann Intern Med. ;107:596–597. doi: 10.7326/0003-4819-107-4-596_2
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Published: Ann Intern Med. 1987;107(4):596-597.
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