To the Editors:
We read with interest the recent paper by ten Brinke et al. 1, which describes the prevalence of comorbidities in “difficult-to-treat” asthmatics and the association with recurrent exacerbations. This adds to other papers examining these factors in similar populations but reached some differing conclusions, which we felt merit further discussion.
The study involved 136 patients initially; however, only 63 patients were included in the main analysis. A total of 54 patients were excluded because of their continuous use of oral steroids as the authors reported that defining an exacerbation was difficult in this group. We are unclear why this could not have been defined as the requirement for an increase in oral steroid above the usual maintenance dose. This would have increased the number of patients in the study and included those with more severe disease. The reader can only assume that the remaining 29 patients are those with two …