Un paciente de 60 años, con obesidad y diabetes mellitus tipo 2, consulta por presentar hipertensión arterial, temeroso de padecer una cardiopatía isquémica. También presenta antecedentes de tabaquismo de 20 cigarrillos/día desde hace 30 años, pero eso no le preocupa. En el interrogatorio refiere, sin darle importancia, y desde hace años tos y disnea de medianos esfuerzos. Muy probablemente ningún internista dude sobre si debemos evaluar y tratar su diabetes mellitus tipo 2 o su hipertensión arterial, estimar su riesgo cardiovascular o si padece un síndrome metabólico, intentar reducir su obesidad y que abandone el tabaquismo; pero ¿le etiquetaríamos de bronquitis crónica o de EPOC?, ¿debemos hacerle una espirometría y un test broncodilatador?, ¿tratar su probable EPOC? Todos sus síntomas actuales probablemente se deban solo a la EPOC.

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilater test, treat his probable COPD? All his current symptoms are probably only due to COPD.