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We agree with Dr Lipworth1 that our study does not address whether treating complex sinonasal disease documented by endoscopy would affect asthma outcomes. This was not the purpose of our study. The purpose of our study was to determine whether treating chronic sinonasal disease in a diverse patient population in a manner analogous to that widely practiced in non–tertiary care specialty practices would improve asthma control.2
Sinonasal disease was determined by using a validated questionnaire with high sensitivity and specificity for determining the presence of sinonasal disease, which was superior to endoscopy and computed tomographic imaging.3 The reason for using a questionnaire rather than invasive testing to document disease was to mirror common clinical practice.
Research personnel were trained in drug administration, and these personnel instructed all participants in use of the study drug. Sinus symptoms improved significantly in adults, suggesting efficacy of the dose of medication used in this population. Our findings are entirely consistent with those of other multicenter studies of nasal steroids in the treatment of asthma.4,5
Our overall goal was to study the treatment of sinonasal disease in a diverse patient population with poorly controlled asthma to maximize the generalizability of the results to clinical practice rather than to test the unified airway disease hypothesis in a highly select group of patients.
Supported by grants from the National Heart Blood and Lung Institute (UO1HL089464, U01 HL089510, and UL1 TR000448) and the American Lung Association. Study drug and placebo were provided by Merck (Whitehouse Station, NJ).
Disclosure of potential conflict of interest: A. E. Dixon’s institution has received funding from the National Institutes of Health and Merck; she has received consultancy fees from Roche and has received grants or has grants pending from Pfizer and receives royalties from Springer. M. Castro’s institution has received funding from the National Institutes of Health (NIH) and has received grants or has grants pending from Boston Scientific, Amgen, Ception, Cephalon, Teva, Genentech, Medimmune, Merck, Novartis, GlaxoSmithKline, Sanofi Aventis, Vectura, Next Bio, and KalosBios; he has received consultancy fees from Asthmatx/Boston Scientific, Genentech, IPS/Holaira, and Neostem; has received payment for delivering lectures from GlaxoSmithKline, Genentech, Boston Scientific, Boehringer Ingelheim, and Teva; receives royalties from Elsevier; and has stock/stock options from Sparo. R. I. Cohen’s institution has received funding from the American Lung Association– Asthma Clinical Research Center. C. G. Irvin has received consultancy fees from TEVA and has received grants or has grants pending from Hydra Bioscience and receives royalties from UpToDate. S. P. Peters has received consultancy fees from the Coordination Center at Johns Hopkins, AstraZeneca, Aerocrine, Airsonett AB, Boehringer Ingelheim, GlaxoSmithKline, Merck, Novartis, Ono Pharmaceuticals, Pfizer, Sunovion, Targacept, TEVA, Pharmaceutical Product Development, LLC, and Quintiles; has received payment for delivering lectures from Integrity CE; and receives royalties from UpToDate. R. A. Wise’s institution has received funding from Merck, as well as consultancy fees from AstraZeneca, Merck, GlaxoSmithKline, Boehringer Ingelheim, Novartis, Pfizer, Mylan, Roche, Janssen, Pulmonx, Spiration, Intermune, Medimmune, Sunovion, and Forest; he has received support for travel and other meeting-related expenses from Forest. The rest of the authors declare that they have no conflicts of interest.