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Ian Nathanson, MD, FCCP; Daniel R. Ouellette, MD, FCCP
Author and Funding Information

Dr Nathanson is the Section Editor for Guidelines and Consensus Statements for CHEST. From the Department of Pulmonary Disease Service (Dr Ouellette), Henry Ford Hospital.

CORRESPONDENCE TO: Ian Nathanson, MD, FCCP, 838 Lake Catherine Ct, Maitland, FL 32751; e-mail: inathanson@cfl.rr.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Nathanson is a former chair of the Guidelines Oversight Committee. Dr Ouellette is the current chair of the Guidelines Oversight Committee. He received a research grant from Cardeas Pharma (principal investigator; all funds to institution) and has been an expert witness on the topic of venous thromboembolism.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):e191. doi:10.1378/chest.15-0182
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To the Editor:

We appreciate Drs Sehgal and Agarwal commenting on our recent point/counterpoint editorials that discussed whether CHEST guidelines are global.1,2 Yet their letter baffles us in that it does not reference a single CHEST guideline. Instead, they discuss why they think a guideline about community-acquired pneumonia published by a joint committee of the Infectious Diseases Society of America/American Thoracic Society3 is not applicable to their practice in India. Perhaps they should have read that guideline more carefully. It contains 49 recommendations, the first of which states that “locally adapted guidelines should be implemented to improve process of care variables and relevant clinical outcomes. (Strong recommendation; level I evidence).”3 In addition, the Purpose and Scope section states unequivocally that “the guidelines are oriented toward the United States and Canada.” Finally, Drs Sehgal and Agarwal write that they recommended against the use of linezolid for nosocomial pneumonia, citing a Letter to the Editor as evidence to support their position. We contend that it would be a rare proponent or critic of evidence-based medicine in North America or India who would support using the contents of a letter as anything other than the lowest form of evidence. Although we welcome other viewpoints, we stand by our position that CHEST guidelines are global.

References

Nathanson I, Ouellette DR. POINT: are the CHEST guidelines global in coverage? Yes. Chest. 2015;147(1):11-13. [CrossRef] [PubMed]
 
Mehta AC, Banga A, Stoller JK. COUNTERPOINT: are the CHEST guidelines global in coverage? No. Chest. 2015;147(1):13-15. [CrossRef] [PubMed]
 
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72. [CrossRef] [PubMed]
 

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References

Nathanson I, Ouellette DR. POINT: are the CHEST guidelines global in coverage? Yes. Chest. 2015;147(1):11-13. [CrossRef] [PubMed]
 
Mehta AC, Banga A, Stoller JK. COUNTERPOINT: are the CHEST guidelines global in coverage? No. Chest. 2015;147(1):13-15. [CrossRef] [PubMed]
 
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72. [CrossRef] [PubMed]
 
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