eLetters

323 e-Letters

  • Reflecting the balance of evidence for salmeterol in COPD
    Michael B Devoy

    Dear Editor

    We would like to comment on strength of conclusions of the recent publication by Dr Brusasco et al,[1] particularly that no consideration is given to how the results compare to the balance of evidence that exists.

    The paper’s conclusions imply superior efficacy of tiotropium over salmeterol in patients with COPD by emphasising endpoints in which tiotropium shows a difference compar...

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  • Surgical Pulmonary Embolectomy
    Holger Klaus Eltzschig

    Dear Editor

    With great interest, we read the guidelines for the management of suspected acute pulmonary embolism (PE) by the British Thoracic Society (June issue 2003).[1] In the discussion of treatment options, the guidelines state that surgical embolectomy should only be considered in cases with absolute contraindications to thrombolysis, which is rarely an important consideration in a life-threatening situat...

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  • New asthma gene
    Dr S K Agarwal

    Dear Editor

    One of the paradoxes of modern medicine is the rapid growing incidence of immune-based diseases over the last half of the century.

    Despite enormous advances in our understanding of the immune system, and our ability to manipulate immunity in experienced animals and man, we have not been able to curtail these diseases. In fact, it is becoming increasing evident that immune hypersensitivity response...

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  • Inappropriate outcomes and flooring/ ceiling effects invalidate study conclusion
    Sarah B Brien

    Dear Editor

    The efficacy and clinical effectiveness of homeopathy engenders considerable debate; it is therefore essential that clinical trials are accurately interpreted and reported. The recent publication by White et al.[1] has highlighted this issue.

    The study, assessing classical homeopathy as an adjunctive treatment for childhood asthma concluded that, based on the primary outcome (the active qua...

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  • Author's reply to Robert Leckridge
    Adrian R White

    Dear Editor

    Dr Leckridge[1] is correct to state that the children in the study had mild to moderate symptoms of asthma at the time of recruitment. Children with more severe symptoms were excluded at the request of the Ethics Committee, because of the risks that could arise if they stopped their conventional medication. Our study tested homeopathy as an adjunct to standard medical management, not an alternative.

    ...
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  • Homeopathy and childhood asthma
    Robert Leckridge

    Dear Editor

    This study of quality of life in children with asthma treated with homeopathy is fatally flawed.[1] The Childhood Asthma Quality of Life instrument used was validated in a study by French et al.[2] The children entered into White’s study had scores consistent with those of normal children who don’t have asthma. For a statistically significant improvement to occur in this score, the treated group wo...

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  • Salbutamol vs aminophylline in severe asthma in children
    Florens GA Versteegh

    Dear Editor

    It is indeed a pity that there was no comparison between continuous aminophylline and continuous salbutamol. The authors did not make it very clear why they did not choose this option. The conclusion that there is some favourable outcome with aminophylline is therefore, in my opinion, too strong for the data they present. Another query is: Why did the authors use aminophylline, instead of theofylline, wit...

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  • Author's Reply
    Bernard G Higgins

    Dear Editor

    We thank Dr Chanarin for his interest in the new Asthma Guideline. We will answer the points made in the order in which he raises them.

    1. The quoted studies on breast-feeding appear to be equivocal in terms of the protective effect on asthma, but both show protection against wheezing illness in the first years of life. The recommendation in the guideline specifies such wheezing illne...

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  • Acidification of Exhaled Condensates in Cystic Fibrosis
    Richard M. Effros

    Dear Editor

    I read with interest the article of Tate et al. indicating that exhaled condensates are acidic in patients with CF and become more acidic during exacerbations. The data show differences in mean values (with some overlap) and the hypothesis that the airways are acidic in these patients seems plausible. However I am concerned that the condensate measurements cannot give a reliable estimate of airway...

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  • BTS and SIGN asthma guidelines
    Nicholas Chanarin

    Dear Editor

    The New Guidelines use evidence based methodology extensively. This methodology has been developed by the Scottish Intercollegiate Guidelines Network and is not only well respected but has been widely applied to develop other guidelines. The guidelines use levels of evidence, I quote
    “Level A is: At least one meta analysis, systematic review, or RCT rated as 1++ and directly applicab...

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