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We are grateful for Dr Palamarthy's comments on our paper. However, we disagree with his suggestion of taking the time of hospital discharge instead of 3 months as the endpoint because the aim of our intervention was to decrease inflammation and it is well known, as reported by Perera and colleagues,1 that inflammation and symptoms may not recover to baseline even 35 days after an exacerbation. In trials that we are about to start, in which patients will be recruited while stable, we have considered clinical outcomes as well as inflammatory and mechanistic variables but, in our view, the time to first exacerbation and the rate of exacerbations would be more reflective of the mechanism of action that we are proposing for low-dose theophylline. Rehabilitation is important and needs to be considered for daily clinical practice, but both arms would eventually be exposed to it so it should not be a confounding factor.
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.
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