We think that our difference of opinion with Dr Orenstein is not one of substance but rather one of semantics that is related to the definition of early intervention. In our letter, we meant to emphasize that a beneficial effect of "prophylactic" therapy, initiated before the onset of clinically apparent pulmonary disease, has not been verified in patients with CF. The data presented by Orenstein et al1 do not address this point. The authors looked at the clinical status at 7 years of age of 16 patients with CF whose conditions were diagnosed and treated before the onset of pulmonary disease (mean age, 6 months) compared with 16 older siblings, most of whose conditions were diagnosed after the onset of pulmonary disease (mean age, 4 years). This was a comparison of early therapy v late therapy. In five of the 16 sibling pairs, the diagnosis of CF
Rosenstein BJ, Langbaum TS. Early Treatment of Cystic Fibrosis-Reply. JAMA. 1982;248(17):2113–2114. doi:10.1001/jama.1982.03330170021013
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