ATS guidelines for methacholine and exercise challenge testing.

We have written an Editorial on paraquat intoxication (1), in which we review the physiopathology, the prognosis, and the treatment of this intoxication. One of the citations was that of Lin and colleagues, published last year in the AJRCCM (2). In this article spectacular results were obtained with respect to patient survival rates, given that some 82% of patients with moderate or severe intoxication survived after receiving, among other measures, pulse therapy with glucocorticoid and cyclophosphamide (CP). However, the dose of CP that appears in the mentioned article is much more toxic than the paraquat itself if we go by what is stated in the M ETHODS section, which says that patients received “15 g/kg of CP in 5% glucose saline 200 ml. . . intravenously infused for 2 h/d” for two days. In previous articles by the same group or by other authors doses of 1 g/day or of 15 mg/kg are used (3, 4). In addition, immunosuppressive therapy using high doses of CP do not usually use more than 7 g/m 2 of body surface (5) or 50 mg/kg/d (6). For these reasons, we believe that the dose of CP stated in the article must be a typographical error and should read milligrams (mg) instead of grams (g). However, until now this error seems not to have been noticed, or at least we have not seen it corrected in subsequent issues of your journal. We are firmly convinced that the treatment described by Lin will be used in many hospitals throughout the world and cited in textbooks of pneumology, critical care, clinical toxicology, emergency medicine, etc. Therefore, as well as informing Dr. Lin of our observation, we have thought it opportune that the readers of the AJRCCM also be informed on this important point, in order to avoid the possibility of treatment guidelines that could have severe consequences for patients suffering from paraquat intoxication.