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Ann Saudi Med 31(4) July-August 2011 www.saudiannals.net 434 exercise, but has serious therapeutic implications. A, M and E phenotypes display different responses to inhaled bronchodilators.4-5 Various studies have concluded that 20% to 40% of “COPD” patients suffer from irreversible asthma.2,6,7 In addition, even in Western countries, bronchiectasis is present in over 10% as an alternative or concomitant diagnosis to COPD.8,9 Many studies in the last few years use terms like “persistent airflow obstruction” or “airway obstruction” or “limitation” to describe undifferentiated airway obstruction.10 The article enforces the message that COPD is one entity and, inadvertently, introduces a new serious precedent: 16% of “COPD” patients smoked for less than 10 years and another 42% less than 20 years. Even at such low levels of smoking a diagnosis of asthma is not a consideration in the article. Adopting this concept would increase expenditures, as COPD is treated with more expensive and numerous inhalers than asthma. Equally importantly, underrecognizing asthma would deny patients specific asthma drugs like anti-IgE therapy (omalizumab) or large doses of inhaled corticosteroids. A total of 1380 patients were screened out of whom 879 were excluded due to “poor performance of spirometry or incomplete data”. This raises doubts about whether the spirometry was done according to standards. Also, the total number diagnosed as “COPD” was only 71 from 60 primary care centers in three regions of Saudi Arabia. Because of lack of power in terms of numbers or stratification, such findings cannot describe the prevalence in health care clinics in Saudi Arabia.