From the Asthma and Airways Centre (Drs L. G. Fritscher, Marras, and Chapman and Ms Bradi), University Health Network, and Asthma Education Clinic (Dr Balter), Mount Sinai Hospital, University of Toronto; Pontifícia Universidade Católica do Rio Grande do Sul (Drs L. G. Fritscher and C. C. Fritscher); and Universidade Luterana do Brasil (Dr L. G. Fritscher), Canoas, Brazil.
Correspondence to: Leandro G. Fritscher, MD, Avenida Ipiranga, 6690/501, Porto Alegre, RS, Brazil; e-mail: email@example.com
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Marras has received honoraria from for AstraZeneca, Bayer, and GlaxoSmithKline, for speaking at CME events relating to mycobacterial infections. During the past 3 years, Dr Chapman has received compensation for consulting with AstraZeneca, Boehringer-Ingelheim, CSL Behring, GlaxoSmithKline, Merck Frosst, Novartis, Nycomed, Pfizer, Roche, Schering Plough, and Telacris; has undertaken research funded by AstraZeneca, Boehringer-Ingelheim, CSL Behring, Forest Laboratories, GlaxoSmithKline, Novartis, Parangenix, Roche, and Talecris; and has participated in continuing medical education activities sponsored in whole or in part by AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis, Nycomed, Pfizer, and Talecris. Drs L. G. Fritscher, C. C. Fritscher, and Balter and Ms Bradi have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
© 2011 American College of Chest Physicians
We thank Dr Nair for his observations, which complement our recent article in CHEST (January 2011).1 We share his concern that nontuberculous mycobacterial infection may complicate troublesome asthma more commonly than is currently recognized and further agree that asthma specialists should be alert to the symptoms and signs of this “difficult-to-treat” asthma variant. Whether these signs and symptoms should be limited to persistent cough, long-standing disease with remodeling, and characteristic radiologic changes or should also include sputum neutrophilia will require further study. Also, the value of detecting sputum neutrophilia as a means of heightening awareness of underlying infection may be insignificant, given the still-limited use of sputum cytology monitoring in asthma management.
It would be helpful to know if the four of 94 patients seen by Dr Nair with nontuberculous mycobacterial infection and asthma were the only four patients with sputum neutrophilia or whether they were part of a larger group of patients whose airway inflammation appeared neutrophilic after suppression of eosinophilia. We look forward to a more detailed description of these findings.
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