eLetters

248 e-Letters

  • 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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  • Man versus machine
    David Fishwick

    Dear Editor

    We read with interest the article by Baldwin et al.[1] relating to the level of agreement between expert clinicians and OASYS software when making a diagnosis of occupational asthma. Our clinical unit uses OASYS plotting regularly, and find this of great use as one element of the diagnostic toolkit available for the confirmation of a diagnosis of occupational asthma.

    We were interested...

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  • Re: Chronic respiratory failure
    Gerben P Bootsma

    Dear Editor

    The recent case report from Smyth and Riley[1] describes nicely an extremely uncommon chronic respiratory failure due to hypoventilation secondary to brainstem stroke, and documents a new treatment option with medroxyprogesterone acetate.

    We recently saw two patients also with central hypoventilation resulting in chronic type II respiratory failure and treated both with, among other things, me...

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  • See top of letter
    John H. Lange

    Dear Editor

    Endotoxin: it’s activity in atopy and asthma is not the only controversial issue – does it play a role in prevention of lung cancer in some occupational populations

    The paper Does environmental endotoxin exposure prevent asthma? by Douwes et al. provides an interesting overview of how endotoxin may interact in atopy and asthma. This paper discusses issues as to whether endotoxin pl...

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  • Marginal benefits of adding formoterol
    Brian J Lipworth

    Dear Editor

    Price and colleages conclude that adding formoterol confers a therapeutic advantage to inhaled steroid in patients with mild to moderate asthma. For the 6 month follow up in part 2 of the study, for the secondary outcome of mild asthma exacerbations,the frequency differed by 2.5 per patient per 6 months ,while for poorly controlled asthma days the difference was 4.2 days per patient per 6 months.

    T...

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  • 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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