On 2016 Aug 28, Santosh Kondekar commented:

The position statement is an intelligent summary of difficult and refractory asthma and its phenotypes; with action plan.Its felt that an attempt should have been made for practitioners to differentiate an exacerbation of asthma from an infection and an infection associated exacerbation. Mixed treatments become a possibility when infection is confused with infection induced exacerbation and/ or the diagnosis of asthma if were empirical by itself; more so in pediatric age group. It will also be wiser to insist for a clinical algorithm of diagnosis or exclusion of non asthma diagnosis. Also use of steroids in labelled "viral associated asthma exacerbation" may in turn be worsening the symptoms; and hence should be cautiously diagnosed. Over last decade, appropriate adherence, compliance and care for co-morbid factors is well understood; but the diagnostic dilemmas and mis diagnosis or over diagnosis is yet to be addressed black and white.

On 2014 Nov 25, Harri Hemila commented:

Custovic A, 2013 state that a significant outstanding problem in the clinical management of asthma is the failure to prevent and/or efficiently treat asthma exacerbations. They point out that the major cause of asthma exacerbations seems to be respiratory infections and suggest that there is need to develop novel treatments for exacerbations.

Strong evidence indicates that, in some conditions, vitamin C can reduce bronchoconstriction. Three RCTs examined the effect of vitamin C on participants suffering from exercise-induced bronchoconstriction Hemilä H, 2013, DOI. The pooled relative effect estimate revealed a 48% reduction in postexercise FEV1 decline when vitamin C was administered prior to the exercise test.

Vitamin C is a water-soluble antioxidant that protects the immune system against oxidative stress generated during infections. It may therefore influence infections. Over two dozen controlled trials have shown that vitamin C shortens the duration and alleviates the symptoms of the common cold. Doses of ≥1 g/day of regularly administered vitamin C shortened the duration of colds in adults by 8% and in children by 18% Hemilä H, 2013, DOI. Given the alleviating effect of vitamin C on colds, it might influence complications of colds, such as asthma exacerbations. A systematic review found three small studies that provided information on the potential pulmonary effects of vitamin C in sufferers of common-cold induced asthma Hemilä H, 2013, DOI. A double-blind placebo-controlled RCT in Nigeria examined asthmatics whose asthma exacerbations resulted from respiratory infections (Anah CO, 1980). Vitamin C lowered the incidence of severe and moderate asthma attacks by 89% (based on 3/22 vs. 23/19). Two other studies found that vitamin C protected against bronchial hypersensitivity to histamine. These findings support the hypothesis that vitamin C might benefit some sufferers of asthma exacerbation during colds.

The meagre interest in the benefits of vitamin C against the common cold is puzzling. Goodwin JS, 1998 DOI provided several examples of a systematic bias against the concept that vitamins might prove beneficial in quantities exceeding the minimum required to avoid classic deficiency diseases. Preconceptions may also explain the meagre interest in the benefits of vitamin C against the common cold Hemilä H, 2013, DOI.

Custovic et al. commented that there is need for novel treatments for asthma exacerbations and vitamin C appears as one of the potential novel treatments warranting further research.

On 2014 Nov 25, Harri Hemila commented:

Custovic A, 2013 state that a significant outstanding problem in the clinical management of asthma is the failure to prevent and/or efficiently treat asthma exacerbations. They point out that the major cause of asthma exacerbations seems to be respiratory infections and suggest that there is need to develop novel treatments for exacerbations.

Strong evidence indicates that, in some conditions, vitamin C can reduce bronchoconstriction. Three RCTs examined the effect of vitamin C on participants suffering from exercise-induced bronchoconstriction Hemilä H, 2013, DOI. The pooled relative effect estimate revealed a 48% reduction in postexercise FEV1 decline when vitamin C was administered prior to the exercise test.

Vitamin C is a water-soluble antioxidant that protects the immune system against oxidative stress generated during infections. It may therefore influence infections. Over two dozen controlled trials have shown that vitamin C shortens the duration and alleviates the symptoms of the common cold. Doses of ≥1 g/day of regularly administered vitamin C shortened the duration of colds in adults by 8% and in children by 18% Hemilä H, 2013, DOI. Given the alleviating effect of vitamin C on colds, it might influence complications of colds, such as asthma exacerbations. A systematic review found three small studies that provided information on the potential pulmonary effects of vitamin C in sufferers of common-cold induced asthma Hemilä H, 2013, DOI. A double-blind placebo-controlled RCT in Nigeria examined asthmatics whose asthma exacerbations resulted from respiratory infections (Anah CO, 1980). Vitamin C lowered the incidence of severe and moderate asthma attacks by 89% (based on 3/22 vs. 23/19). Two other studies found that vitamin C protected against bronchial hypersensitivity to histamine. These findings support the hypothesis that vitamin C might benefit some sufferers of asthma exacerbation during colds.

The meagre interest in the benefits of vitamin C against the common cold is puzzling. Goodwin JS, 1998 DOI provided several examples of a systematic bias against the concept that vitamins might prove beneficial in quantities exceeding the minimum required to avoid classic deficiency diseases. Preconceptions may also explain the meagre interest in the benefits of vitamin C against the common cold Hemilä H, 2013, DOI.

Custovic et al. commented that there is need for novel treatments for asthma exacerbations and vitamin C appears as one of the potential novel treatments warranting further research.

On 2016 Aug 28, Santosh Kondekar commented:

The position statement is an intelligent summary of difficult and refractory asthma and its phenotypes; with action plan.Its felt that an attempt should have been made for practitioners to differentiate an exacerbation of asthma from an infection and an infection associated exacerbation. Mixed treatments become a possibility when infection is confused with infection induced exacerbation and/ or the diagnosis of asthma if were empirical by itself; more so in pediatric age group. It will also be wiser to insist for a clinical algorithm of diagnosis or exclusion of non asthma diagnosis. Also use of steroids in labelled "viral associated asthma exacerbation" may in turn be worsening the symptoms; and hence should be cautiously diagnosed. Over last decade, appropriate adherence, compliance and care for co-morbid factors is well understood; but the diagnostic dilemmas and mis diagnosis or over diagnosis is yet to be addressed black and white.