eLetters

245 e-Letters

  • Acidification of Exhaled Condensates in Cystic Fibrosis
    Richard M. Effros

    Dear Editor

    I read with interest the article of Tate et al. indicating that exhaled condensates are acidic in patients with CF and become more acidic during exacerbations. The data show differences in mean values (with some overlap) and the hypothesis that the airways are acidic in these patients seems plausible. However I am concerned that the condensate measurements cannot give a reliable estimate of airway...

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  • BTS and SIGN asthma guidelines
    Nicholas Chanarin

    Dear Editor

    The New Guidelines use evidence based methodology extensively. This methodology has been developed by the Scottish Intercollegiate Guidelines Network and is not only well respected but has been widely applied to develop other guidelines. The guidelines use levels of evidence, I quote
    “Level A is: At least one meta analysis, systematic review, or RCT rated as 1++ and directly applicab...

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  • Author's reply
    Bart P Thoonen

    Dear Editor

    In their response to our article Dr Griffiths makes some important remarks, which we would like to comment on.

    We did indeed take clustering into account in the analysis of our data. As stated in the methods section of our paper we used multilevel models.[1] In this multilevel model practices were included as the level of clustering in these models.

    A second methodological questio...

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  • Author's reply to Dr Martin Olmedo
    Bart P Thoonen

    Dear Editor

    In a reaction to our paper Dr Martin Olmedo asks what factors may explain the observed better control of illness in our self-management group.

    The self-management program in our study consisted of education, skills training and written instructions for autonomous adaptation of maintenance therapy with inhaled corticosteroids. As this intervention consisted of more than one element, it is n...

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  • Buteyko
    Alexandra Hough

    Dear Editor

    Thank you for a well-reasoned explanation on the effect of yoga on asthma.

    The study quoted [1] which justifies the Buteyko technique was flawed by:
    * unequal groups in that the Buteyko group initially required 1½ times the steroids of the control group
    * the Buteyko group receiving seven times the follow-up phone calls as the control group, plus extra breathin...

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  • Re: Self-management of asthma in general practice, asthma control and quality of life
    Pablo J Martin Olmedo

    Dear Editor

    I would like to ask the authors a question:

    In the results we can observe that the control of illness is better in the SM group but you say also that there were a saving in inhaled corticosteroids.... so how can you explain the best control? May be the environmental control or there are others explanations?

  • Self management of asthma in primary care
    Chris Griffiths

    Dear Editor

    Evidence that self management programmes for asthma are effective in primary care is elusive.[1] Thoonen and colleagues have carried out a complex and impressive cluster randomised trial from which they conclude that a self management programme implemented in Dutch general practices lowers the burden of illness.[2] Parts of their analysis require comment.

    It is not clear whether clustering has bee...

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  • Re: Medication compliance and difficult-to-treat asthma
    Andrew Bush

    Dear Editor

    We thank Dr Agarwal for responding to our article. We agree that the commonest cause of steroid resistant asthma is failure to take the prescribed steroids. However, there are perhaps more diagnostic aids than is acknoweldged. Compliance can be taken out of the equation by doing a therapeutic trial of a single intramuscular injection of depot triamcinolone.[1-4] If asthma persists, then it can truly be...

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  • Medication compliance and difficult-to-treat asthma
    SK Agarwal

    Dear Editor

    Medication compliance in asthma is disappointingly low and leads to poor asthma control in children. It is very common that parents do not supervise treatment and often report poor asthma control. Many difficult-to-manage asthmatics have ongoing exposure to allergens or other asthma triggers. In such instances, required medication may be very high and the results may be disappointing. Only 30% of pediatric a...

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  • Response to David Fishwick
    P Sherwood Burge

    Dear Editor

    Experts were given no clinical details except for times of waking and sleeping, and times of starting and leaving work. They were asked to make judgements based on the peak expiratory flow record alone, similar to the judgements made by the Oasys program. Oasys-2 has been shown to have a sensitivity of around 70%, when tested against independent objective diagnoses (mostly specific bronchial provocation t...

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