It is quite clear that Drs Chernow and Castell agree with the concepts set forth in my article: that adults with severe asthma have hiatal hernia and reflux more frequently than age-matched controls and that it appears quite likely that a cause and effect relationship between the two conditions exists. The advantages of widespread recognition of this concept are obvious, if one considers the prevalence of intrinsic asthma in the population.
What, then, does their letter question or add to our knowledge on the point? In my report, no claim is made of having demonstrated aspiration in any patient. In fact, the commentary mentions the extreme difficulty that may be experienced in establishing definitive prospective proof of a cause and effect relationship between reflux and pulmonary symptoms. Similarly, although the UGI series was used as a screening test for reflux, I wrote that "more generally acceptable methods to
Mays EE. Asthma and Gastroesophageal Reflux-Reply. JAMA. 1977;237(22):2379. doi:10.1001/jama.1977.03270490019006
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