eLetters

231 e-Letters

  • Reply to Fowler: Clinical relevance of AMP challenge in asthma
    Riccardo Polosa

    Dear Editor

    We thank Dr Fowler for allowing us to expand further on the subject matter of AMP provocation clinical relevance. Could AMP be the preferred challenge stimulus for monitoring treatment requirements in asthma and to establish the appropriate dose of inhaled GCS needed to control airway inflammation? Although the available evidence clearly indicates that AMP challenge has a selective ability to probe cha...

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  • DOT for all patients with smear-positive pulmonary TB in London?
    RD Barker

    Dear Editor

    Supervised drug-taking is frequently seen as the answer to rising levels of tuberculosis. Djuretic et al. advocate directly observed therapy (DOT) for all patients with smear-positive pulmonary tuberculosis in London.[1] At first sight, the experience of instituting DOT in New York City appears especially impressive, with a 21 % reduction in case rates 2 and 39 % decrease in drug-resistant isolates....

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  • Re: Sampling in tuberculosis RFLP clustering analyses
    Helen Maguire

    Dear Editor

    Paynter and Coker have made an important point about the extent to which clustering depends upon sample coverage. We believe that this is valid, but strictly correct only in the situation where a representative (e.g. random) sample of the population have been studied. In our study we included 2490 isolates with linked demographic information. This is 77 % of the total of 3260 culture-confirmed cases...

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  • Neutrophil involvement in mild asthma.
    David W Reid

    Dear Editor

    We wholeheartedly welcome the article by Douwes et al. and it’s accompanying editorial by O’Donnell and Frew.[1,2] The review highlights the heterogeneity of airway inflammation in 'asthma' and especially the potential role of the neutrophil in a substantial proportion of patients. The authors use the term 'non-eosinophilic asthma' to categorise this disease entity and they state that other manif...

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  • Sampling in tuberculosis RFLP clustering analyses
    Stuart J Paynter

    Dear Editor

    Maguire et al.[1] estimated recently in the journal that the rate of recent transmission of M tuberculosis in London was 14.4 % between 1995 and 1997. Estimation of this parameter is an important contribution to the understanding of transmission dynamics of tuberculosis in the capital and should assist policy-makers in developing responses to enhance control. We suggest, however, that if this estim...

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  • Mechanism of airflow obstruction in PPH
    Tarek Saba

    Dear Editor

    I read with interest the paper by Meyer et al about the increased incidence of peripheral airflow obstruction in 171 patients with PPH when compared to 64 age and sex matched controls. [1]

    The authors speculate on possible explanations for this finding. They provide three main theories, all of which are plausible. First, that increased production of cytokines and growth mediators in...

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  • AMP challenge in asthma
    Stephen J Fowler

    Dear Editor

    Dr Polosa and colleagues provided an informative review of the mechanisms and clinical application of bronchial challenge with adenosine monophosphate (AMP) in asthma and COPD.[1] I would however contest their proposal that AMP may be the preferred challenge stimulus for monitoring treatment efficacy, as well as disease progression and severity when compared with direct agents such as methacholine, and a...

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  • Socioeconomic gradient related to respiratory complaints in pupils
    Coppieters Yves

    Dear Editor

    Such as the paper from Dales et al. concerning the influence of family income on asthma morbidity,[1] understanding socioeconomic effects on adolescent health is a critical and important area of research if we are to eliminate health disparities.[2] Moreover, traditionally used tools to evaluate socio-economic gradient are difficult to construct within this population and new indicators must...

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  • HIV and TB
    Bello S Oricha

    Dear Editor

    The relationship between HIV and tuberculosis are probably predictable. Both are lentiform diseases and immuno suppressive. Primary tuberculous lesions may be re-activated in an immuno suppressive state and new infections are more easily established. The real danger is that one partner (tuberculosis) of this vicious circle is transferable by droplet infection and in its presence the precaution required o...

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  • Are type 1 and type 2 reponses really reciprocal?
    Wendy JA Anderson

    Dear Editor

    I read with interest the paper by Papadopoulos et al. describing the balance between type 1 and type 2 responses by CD4 and CD8 T lymphocytes in atopic asthmatics and normal subjects stimulated by rhinovirus. They state that their data is consistent with ‘reciprocal regulation of type 1 and type 2 responses’. Their figure demonstrates that in both normals and atopic asthmatics interferon gamma and in...

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