The term “muddying the waters” is used to describe a situation where the events or facts are not clear or have been distorted by some element.  I was thinking of this phrase yesterday when I was reviewing new information on COPD. I go back at least 4 decades in the pulmonary medicine business and, as you can imagine, approaches and ideas about this disease have changed dramatically. One of the best examples of this advancement is the number of medications which are now available, but more importantly are the various subtypes of disease where some of these medications should be used.

            In the past a great deal of emphasis was placed on making an accurate diagnosis of COPD utilizing pulmonary function studies and radiographic techniques.  This first step is still important, but along with the new medications have come studies about subgroups of patients with COPD.  For example, some patients may have certain genetic deficiencies, some may have combined problems such as COPD and asthma, and some patients may have elevated levels of blood cells, called eosinophils, which may reflect which medications may be most helpful.

            Simply diagnosing COPD is no longer enough.  We now must look for these special issues to better help our patients.

            By the way, for those who like music and specifically the “blues”, Muddy Waters is the professional name of McKinley Morganfield often called the “father of modern Chicago blues”.  He died in 1983 and is remembered as an important figure on the post-war blues scene.