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  1. Ian Pavord1,
  2. Peter G Gibson2
  1. 1Glenfield Hospital, UK
  2. 2Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
  1. Correspondence to Professor Ian Pavord, Glenfield Hospital, UK; ian.pavord{at}uhl-tr.nhs.uk

https://doi.org/10.1136/thoraxjnl-2012-202318

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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 al 4 where a serious design limitation also prevented optimal assessment of the technique.2 ,5

    References

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      Use of sputum eosinophil counts to guide management in children with severe asthma. Thorax 2012;67:1015 6.
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      . Inflammometry: the current state of play. Thorax 2012;67:191–2.
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      1. Fleming L,
      2. Wilson N,
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      . Use of sputum eosinophil counts to guide management in children with severe asthma. Thorax 2012;67: 193–8.
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      1. Szefler SJ,
      2. Mitchell H,
      3. Sorkness CA,
      4. et al
      . Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet 2008;372:1065–72.
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    5. ↵
      1. Gibson PG
      . Using fractional exhaled nitric oxide to guide asthma therapy: design and methodological issues for ASthma TReatment ALgorithm studies. Clin Exp Allergy 2009;39:478–90.
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    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; internally peer reviewed.