Projections of COPD in males in the Netherlands

Abstract

the initial invasive staging modality after bronchoscopy plus TBNA.Since the publication of our editorial comment, two further prospective studies have investigated the addition of EUS-FNA to a standard work-up for unselected LC patients [3,4]. In one of these studies, the results of EUS-FNA were blinded [3]. The conclusions were clear; EUS-FNA, when added to MS (and TBNA), improves the pre-operative staging of LC, resulting in a reduced rate of futile thoracotomies.How much additional proof do we need? Should we ask for more evidence from new less invasive methods that exists for the standard methods? When is the right time to change or add to standards? We believe, based on the current literature, that the time has come for EUS-FNA.However, the aim of our editorial comment was not to claim the superiority of one method above the other, but to inform thoracic specialists that, according to the available evidence, the addition of endoscopic ultrasound-guided fine-needle aspiration to a standard work-up improves selection of surgically curable patients with lung cancer. While recognising that the primary purpose of the authors' model is to estimate total future costs due to chronic obstructive pulmonary disease, regardless of how these costs arise, the authors hardly comment on the extent to which their estimates depend on demographic changes, in particular, increased age of the population (which perhaps represents medical ''success'' but increases costs and worries pension funds) and how much depends on the persistence of smokingrelated disease (which is amenable to preventive medicine). The increases presented for prevalence and mortality could potentially be explained entirely by population ageing, but there is no quantification of these two major factors to support or refute this possibility. Such information might help the medical reader to better understand the paradox that, while smoking is the most important aetiological factor for causing physician-diagnosed chronic obstructive pulmonary disease, its prevalence and mortality can be projected to continue to increase even after 45 yrs of reduction in cigarette smoking by Dutch males. Projections of COPD in males in the Netherlands