243 e-Letters

  • Inspiratory Muscle Training - The need for multiple tests to assess effectiveness
    Ashwin Rajhan

    We would like to congratulate Bissett et al on performing a clinically important study in a challenging cohort of Intensive Therapy Unit (ITU) patients. Any information in assisting the weaning process of ITU patients is clearly very important and clinically very useful.

    It is interesting that Maximum Inspiratory Pressure (MIP) was used to assess the inspiratory muscle strength (IMS), one of the primary endpoint...

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  • Re:Hypotheses to explain the reduced sensitivity of tuberculin skin test in BCG immunised young children
    James A. Seddon

    Dear Editor,

    We appreciate the comments by Dr Eisenhut.(1) We did not focus on the sensitivity analysis in our study as we were primarily interested in establishing the impact of BCG on interpretation of tuberculin skin test (TST) responses, which we considered especially relevant in the context of the new NICE guidance.(2) The points raised by Dr Eisenhut are interesting and we agree that the hypotheses put forwa...

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  • Chronic e-cigarette exposure in mice induces features of COPD in a nicotine-dependent manner?
    Riccardo Polosa

    F.Guarino and R.Polosa

    We read with great curiosity the article by Garcia-Arcos et al. (1) suggesting nicotine as a novel causative factor for the onset and progression of COPD/emphysema. Chronic nicotine exposure from nebulized e- liquid (in toxic concentrations) appears to modify inflammation, ion conductance and mucociliary function in HBECs and induces airway hyper- reactivity and air space enlargement in A/J...

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  • Response to 'Pulmonary rehabilitation for patients with COPD: integrated care or home alone?'
    Anne E. Holland

    We thank Vanfleteren and colleagues for their comments on our recently published equivalence trial comparing home-based and centre-based pulmonary rehabilitation in people with stable chronic obstructive pulmonary disease (COPD).[1] We agree that there is a compelling need to increase the implementation, utilization and delivery of pulmonary rehabilitation.[2] We welcome further discussion regarding the role of new pulmon...

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  • Pulmonary rehabilitation for patients with COPD: integrated care or home alone?
    Lowie E.G.W. Vanfleteren

    Based on their findings from a prospective, randomized, controlled equivalence trial, Holland and colleagues conclude that a 8-week home- based rehabilitation model produced short-term clinical outcomes that were equivalent to a center-based pulmonary rehabilitation program.[1] To their credit, the authors' recruitment and statistical design were of high quality, as were the outcome measures used. We acknowledge that the...

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  • Hypotheses to explain the reduced sensitivity of tuberculin skin test in BCG immunised young children
    Michael Eisenhut

    In a recent cohort study investigating tuberculin skin test (TST) in relation to interferon gamma release assay (IGRA) responses in exposed children and relating responses to previous BCG immunisation the authors reported a reduced sensitivity of TST using IGRA as a reference standard at all induration thresholds for young children (less than 5 years old) who had a previous BCG immunisation compared to those who didn't(1...

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  • Neurohumoral activation as a link between FEV1 and CVD
    Stefan Andreas

    Dear Editor,

    with the greatest interest I have read the publication "Lung function and airway obstruction: associations with circulating markers of cardiac function and incident heart failure in older men--the British Regional Heart Study" by Wannamethee et al. (Thorax 2016 71:526-534). Analyzing a large database with 13 years of prospective follow up the authors conclude that "reduced FEV1 reflecting airflow ob...

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  • Authors Reponse: Exercise induced bronchoconstriction (EIB) in elite athletes: measuring the fall ?
    John W Dickinson

    Dear Editor,

    We would like to thank Lindley and Mickleborough for their comments on our paper (1) recently published in the Thorax journal. We agree that eucapnic voluntary hyperventilation (EVH) challenges provide greater sensitivity when compared with exercise challenges in the diagnosis of EIA in elite athletes and have recently published data supporting this hypothesis (2). Despite the greater sensitivity pr...

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  • Doubting the efficacy of pneumococcal vaccination
    Alyn H Morice

    Dear Editor,

    I read with interest the paper by Alfageme and colleagues (1) who investigated the efficacy of anti-pneumococcal vaccination in patients with COPD. To have new data in an area which has suffered from a surfeit of meta-analysis and even analysis of the meta-analysis is good and their results are quite clear. Although they do not specifically comment I presume that their primary end point was accum...

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  • The authors’ response to Dr Quanjer
    Pim A de Jong

    Dear Editor,

    We appreciate the comments made by Prof. Quanjer concerning our manuscript (1) and fully agree with his comments. In his letter to the editor Prof. Quanjer gives valuable background information to the reasons why pulmonary function tests are relatively insensitive to track pulmonary changes in the longitudinal follow up of cystic fibrosis (CF) lung disease (2). We agree with his arguments that this is...

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