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Rebuttal From Dr Shifren et alRebuttal From Dr Shifren et al

Adrian Shifren, MD, FCCP; Alex Chen, MD; Mario Castro, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine.

Correspondence to: Mario Castro, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: castrom@wustl.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts: Dr Castro has received university grant monies (each >$100,000) from the National Institutes of Health, Centers for Disease Control and Prevention, and ALA and pharmaceutical company grant monies (each >$100,000) from Asthmatx, which developed and markets the Alair Bronchial Thermoplasty System discussed in this article, Amgen, Cephalon, Centocor, GlaxoSmithKline, Genentech, Medimmune, Merck, Novartis, and Pfizer. Dr Castro has received consultancy fees ($10,001-$50,000) from Asthmatx, advisory board fees ($5,001-$10,000) from Genentech, and royalties from Elsevier. Dr Castro has been a consultant for Genentech and participated in speaking activities for AstraZeneca, Boeringer-Ingelheim, Genentech, Merck, and Pfizer. Drs Shifren and Chen report 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


Chest. 2011;140(3):577-578. doi:10.1378/chest.11-1411
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Our colleagues Drs Michaud and Ernst1 state, “Airway remodeling with an increase in airway smooth muscle mass and resultant reduction in airway luminal area is believed to be a result of poor asthma control.” We believe the opposite is in fact true: that poor asthma control is the functional end result of untreated airway inflammation and, consequently, airway remodeling.2 Therefore, the proposed mechanism of action of bronchial thermoplasty is that of “reversal” of the smooth muscle component of airway remodeling through thermal ablation, which will then result in improved asthma control.

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