CHEST Guidelines-Response

Response_chest (18)
Pdf Summary
The text presents a scholarly exchange on the study of aspiration's role in asthma, focusing on pepsin as a biomarker for gastric reflux. The correspondents, Jian-jun Ren, Jing Wang, Yu Zhao, and Zhao-ping He, raise questions regarding the type of pepsin referenced in the research, suggesting Pepsin A likely refers to pepsinogen A due to its stability in non-acidic environments. They highlight the discrepancy between reported pepsin levels in aspiration and serum, questioning whether the measured pepsin could originate from serum pepsinogen, potentially misleading the study's implications on gastric reflux detection.<br /><br />In their response, Desmond M. Murphy, Chris Ward, Eoin B. Hunt, John MacSharry, and Jeffrey P. Pearson clarify their study focused on Pepsin A, indicating that any inactivation by pH wouldn’t affect antibody binding used for detection. Their findings reported pepsin presence in the airway of asthmatic patients, yet without a direct correlation to asthma severity. They acknowledge the inquiry into serum and airway pepsin relationships as valid, indicating further research needed to explore aspiration's role across respiratory conditions.<br /><br />Furthermore, the document touches upon another discussion about the impact of intensive urine output monitoring on patient mortality in critical care, highlighting potential data inconsistencies regarding acute kidney injury (AKI) reporting and survival benefits from such monitoring. The correction requested addresses the reported hazard ratios suggesting improved survival with intensive monitoring, which appear at odds with the study's narrative.<br /><br />The text concludes with calls for additional investigation into these biomedical questions, emphasizing the need for rigorous examination and evidence-based exploration of clinical practices and biomarkers in respiratory and critical care medicine.
Keywords
aspiration
asthma
pepsin
gastric reflux
biomarkers
Pepsin A
serum pepsinogen
urine output monitoring
acute kidney injury
critical care