Question special
Chief Resident

Hello everyone! Thank you first and foremost to the authors and NEJM360 for this opportunity to host this journal club, we are very excited for this opportunity. Here is some context for my question above:

I was intrigued by Figure 2 which describes the effect of the intervention on use of antibiotics in the first 4-weeks stratified by the severity of exacerbation as defined by number of Anthonisen Criteria present. It does not appear that there was any differential effect of antibiotic use observed based upon severity of COPD at baseline, but there was a clear differentiation in the use of antibiotics at 4 weeks for those with 2-3 Anthonisen criteria, or perhaps a “more severe” exacerbation at randomization (I believe Table S11 in the Supplementary Appendix describe these subgroup analyses). This was amazing to see, and somewhat surprising as I would anticipate these patients would have a more compelling clinical presentation that would prompt a physician to prescribe antibiotics and ignore a low CRP (GOLD criteria for example encourage antibiotics for moderate-severely ill patients with purulent sputum) as compared to the 1/3 Anthonisen Criteria group that had no difference in antibiotic use.
I wonder if in the future we would be able to ‘target’ a specific population of patients with CRP testing. I know the intent of this study was to determine the effect of POCT testing for all, but I am curious to hear opinions about whether a specific patient population may benefit more from this testing?