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We would like to thank the reviewer for taking
interest in our study. In our study, the ratio of the case to control
was 3:1. Wacholder, et al. [1] have reported that the best way to
increase precision in a case-control study is to increase the number of
cases by widening the base geographically or temporally rather than by
increasing the number of controls because the marginal increase in
precision from an additional case is greater than from an additional
control.
In a metanalysis done by
Rachelefsky, et al. [2]
ICS metered-dose inhaler (MDI)
device was associated with a 5-fold greater risk of oral candidiasis as
compared to placebo. Increased risk of fungal colonization has been
demonstrated in numerous studies as suggested by the reviewer. As we
could not find much literature on the colonization pattern of bacterial
flora in asthmatic children on ICS, our study mainly focused on
bacterial colonization.
In our study, except three, all the asthmatic
children were compliant with the prescribed medicines. None of these
three children had colonization of nasopharynx by the pathogenic
organisms.
According to GINA guidelines, for children less than
5 years, a low dose of inhaled budesonide with spacer was 200 mg
and 400mg were
considered as double low dose ICS [3]. In asthmatic children younger
than 5 y, colonization with pathogenic organism was found in 31% of
asthmatic children who were taking low dose ICS as compared to 40% of
asthmatic children who were taking double low dose ICS, which was not
statistically significant (P = 0.72), but for maintaining
uniformity, we considered Double low dose ICS as the medium dose of ICS
in our analysis.
REFERENCES
1. Wacholder S, McLaughlin JK, Silverman DT, Mandel
JS. Selection of controls in case-control studies. I. Principles. Am J
Epidemiol. 1992a;135:1019-28.
2. Rachelefsky GS, Liao Y, Faruqi R. Impact of
inhaled corticosteroid-induced oropharyngeal adverse events: Results
from a meta-analysis. Ann Allergy Asthma Immunol. 2007;98:225-38.
3. Global Strategy for Asthma Management and Prevention. Global
Initiative for Asthma (GINA), National Heart, Lung and Blood Institute,
US Department of Health and Human Services: National Institute of Health
(NIH); 2015.
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