From the authors
C. Butler and L.G. Heaney raise several important points regarding our recent report 1, which identified risk factors of frequent exacerbations in difficult-to-treat asthma. First, they questioned why we excluded patients on oral corticosteroids from the analysis. In our clinic, and in most other pulmonary clinics, it is common practice to taper oral corticosteroids to the lowest possible dose whenever possible, and to increase the dose no more than strictly necessary in case of the worsening of asthma symptoms. This is a continuing process, mostly initiated by the patients themselves, without interference of a pulmonologist. We chose not to include patients on oral corticosteroids, because we felt that initial exacerbations could not be distinguished clearly from …