Although, as pointed out by Dr Cowl, a prior power calculation was not performed in our study, this limitation would be unlikely to have affected the conclusions drawn from the study. We observed that in unadjusted comparisons there was a borderline-significant difference in the bronchoscopist-assessed airway secretions between patients receiving anticholinergic premedication and those receiving placebo. However, after adjusting for age, sex, smoking history, bronchoscopic biopsy, procedure time, operator experience, and baseline hemodynamic variables and oxygen saturation, the use of anticholinergic premedication was associated with significantly lower airway secretions as reported by the bronchoscopist. Because excessive airway secretions are rarely encountered at bronchoscopy,3 the antisecretory effects of atropine-like drugs might not have been appreciated in the earlier studies, given their limitations in sample size and failure to account for confounding factors. The absence of excessive airway secretions at bronchoscopy, even without antisecretory premedication, might also explain why such premedication may not be associated with clear clinical benefit to the patient in terms of reduction in cough, patient discomfort, development of oxygen desaturation, or time taken for bronchoscopy. In summary, the comments by Dr Cowl that antisecretory drugs prior to bronchoscopy are not beneficial and actually could be harmful in some patients and that the routine use of anticholinergic premedication during bronchoscopy should be abandoned are well supported by evidence, including that from the current study.