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Ultrastructural examination of bronchial specimens from children with moderate asthma
  1. A Bush1,
  2. J C de Jongste2,
  3. K-H Carlsen3
  1. 1Reader in Paediatric Respirology, Imperial School of Medicine at the National Heart and Lung Institute, London SW3 6NP, UK; a.bush{at}rbh.nthames.nhs.uk
  2. 2Professor of Paediatric Respiratory Medicine, Department of Paediatrics, Erasmus University, Medical Centre/Sothia Children’s Hospital, 3000, CB Rotterdam, The Netherlands
  3. 3Professor of Paediatrics, Voksentoppen Children’s Asthma and Allergy Center, N-0394 Oslo, Norway
  1. H Çokuğraş4
  1. 4Sükran Çiftligi Sok, Onur Ap, Bakýrköy, Istanbul, Turkey; cokugras{at}turkpediatri.org.tr

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We have read the paper by Çokuğraş and colleagues on bronchial biopsies in asthmatic children with great concern.1 These authors performed a study in asthmatic children in which prophylactic medication was discontinued for 1 month before a bronchoscopic examination which was performed solely as a research procedure.

The Royal College of Paediatricians and Child Health states that “High risk procedures such as lung or liver biopsy, arterial puncture, and cardiac catheterization are not justified for research purposes alone. They should be carried out only when research is combined with diagnosis or treatment intended to benefit the child concerned”.2 Other authorities state that “Non-therapeutic research is particularly difficult to defend in moral terms when undertaken on children”.3

The risks of rigid bronchoscopy are surely no less than an arterial puncture, and discontinuing presumably necessary medication could only increase those risks. How can such a study possibly be justified by the authors or their ethics committee, and how can the Editors of a reputable journal possibly justify the publication of such a study? That the science is valuable is unquestionable, even though the use of more sophisticated pathological techniques would have enhanced it; but the scientific value by no means justifies the disregard of ethical principles. A journal such as Thorax should know better, particularly in the light of the scholarly and ethical review in the very same issue.3

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Author’s reply

In our study all the parents were informed and gave their consent. At the time of the examination all children were clinically stable. We stopped inhaled steroid and sodium cromoglycate treatment 4 weeks before bronchoscopy and followed each patient very closely. The parents were informed about the probable complications of stopping treatment and we agreed to give bronchodilators such as salbutamol in cases of exacerbation; however, no exacerbations occurred. If it occurred we could exclude the patient before bronchoscopy; the life and the comfort of all our patients is very precious to us.

I believe this study is very important for childhood asthma as it shows that bronchial inflammation of children with moderate asthma is very similar to that observed in adults, which is important for diagnosis and for treatment.

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