Placebo and other interventions in asthma.

To the Editor: Wechsler et al. (July 14 issue)1 describe self-reported outcomes of albuterol treatment as compared with placebo in patients with mild-to-moderate asthma. One possible explanation for the lack of incremental benefit with respect to these outcomes may be related to the experimental design of the study. The benefit of the bronchodilator effect of albuterol could have not been appreciated by patients who were probably asymptomatic and had baseline mild airway obstruction, particularly because they were evaluated under resting conditions for 2 hours in a hospital setting. More information could have been obtained about subjective outcomes by allowing the patients to do some standardized tasks that simulate real-life conditions such as walking or climbing stairs and not just remaining seated in a hospital waiting room.