—I read with considerable interest the article by Harper et al.1 Because of the size of the patient population potentially affected by their findings, this is a very important work, and the authors are to be congratulated for undertaking such a difficult investigation. I would like to raise one very important question, however, in regard to the interpretation of their findings. The authors took pains to select a patient population with the nonallergic type of asthma. Although details of steroid therapy were not given, the patient population was presumably steroid-dependent, since the authors note a steroid burst was given to some patients prior to endoscopy. Although the pathogenesis of this form of asthma remains unknown, histologic studies have revealed that the inflammatory lesion appears to involve principally lymphocytes and mononuclear phagocytes, along with intense infiltrates of eosinophils, which may mediate most of the bronchial mucosal damage. Evidence has emerged
Maddox DE. Treatment of Gastroesophageal Reflux-Induced Asthma: Steroids, ß2-Stimulants, and H2-Blockers-Reply. Arch Intern Med. 1987;147(5):997. doi:10.1001/archinte.1987.00370050189039
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