| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Servei Pneumologia – URMAR, Hospital del Mar – IMIM, CEXS Dept, UPF, Barcelona, Spain
We would like to thank O. Löwhagen for his comments and suggestions on our recent article published in the European Respiratory Journal 1. We shall try to respond to and clarify his doubts to the best of our ability.
Regarding the definition of "near-fatal asthma" (NFA), we have to recognise that, due to the space limitations, this was not extensively covered in the final version of the paper. However, we did devote at least eight lines to defining this group (page 219, last two lines, and page 210, first six lines). NFA criteria were those established by a panel of experts from 10 different countries participating in a multinational project, the European Network for Understanding the Mechanisms of Severe Asthma (ENFUMOSA; ref BMH4-96-1417, EC) 2, the purpose of which, accordingly, was to investigate, in depth, the clinical, physiological and biological mechanisms of severe asthma. O. Löwhagen can find more details in a previous paper of the ENFUMOSA study group 3. With the same concern in mind, our colleague asks about other details, such as whether the patients have visited an emergency room or what their lung function was like. If he re-reads the paper carefully he will notice that "all patients had been hospitalised due to asthma" (page 219, lines 2 and 3) and the NFA "had a history of at least one NFA attack" (which of course implies at least one visit to an emergency room) (page 219, lines 4–6). Lung function is specifically referred to in table 1. Regarding a wider definition of NFA attack, we transcribe here the agreement of the ENFUMOSA panel: "a respiratory arrest and/or Pa,CO2 <50 mmHg" 4.
O. Löwagen also asks for the hypothesis, but this is specifically provided in the paper (page 219, Introduction section, lines 19–23): "...those patients who have experienced NFA should report a lower perception of dyspnoea". We agree with our colleague that "some of the believed asthma symptoms are not indicators of bronchial obstruction"; however. we disagree with both the synonymy he establishes between "airway obstruction" and "asthma", and the splicing of the current concept of asthma into many other subconcepts. The accepted definition of asthma is "...a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment" 5. The presence of a disturbance of the breathing regulation does not exclude, in any case, the diagnosis of asthma in the same way that airway obstruction is not equivalent to asthma.
Regarding functional data following exercise, these are not included in the paper since it was not one of the objectives. However, determinations of static lung volumes, specific airway resistance (SRaw) and maximal inspiratory pressures were performed at the end of all exercises, since a complementary study was conducted to investigate the effects of different efforts on muscle and lung function. Significant changes in SRaw were observed following general exercise and the threshold inspiratory loading test 6. Unfortunately, we were not able to also record lung function "during the exercise", as suggested by the reviewer.
We trust these answers will have served to convince our colleague.
REFERENCES
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
