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We thank Fleming and Bush for their comments1 on our editorial2. We accept that there is no good evidence of a dose-response relationship against eosinophilic airway inflammation with higher dose inhaled steroids in children with asthma. We also recognise that it might be difficult to justify high dose inhaled corticosteroids, or treatment with regular oral corticosteroids in a child with few symptoms. However, the fact remains the principle of sputum based inflammation monitoring has not been tested by this study,3 yet the paper is being presented as a test of that process. In this respect, the manuscript is similar to that of Szefler et al4 where a serious design limitation also prevented optimal assessment of the technique.2 ,5
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
Response to letter from Fleming et al referring to Thorax 2012;67:193–8 ‘Use of sputum eosinophil counts to guide management in children with severe asthma’.