{'fraction_non_alphanumeric': 0.018787878787878787, 'fraction_numerical': 0.006060606060606061, 'mean_word_length': 4.938848920863309, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Cardiac arrhythmias: theory and practice

SIR,-Dr Jenkinson makes some valuable points. We agree that undertreatment of children with asthma is common. In this study, however, over half the children were regular outpatient attenders and many of them attended a specialised asthma clinic. The amount of medication, method of administration, and written instructions were given to a large proportion of the children. They were not inadequately treated by conventional means. They were not, however, treated by three to four Rotacaps or six to eight puffs of aerosol for an exacerbation. Dr Jenkinson's observations need further study. We do not wish to imply that nebulised salbutamol is the only effective way to deliver bronchodilators, but published work suggests that nebulised salbutamol is more effective than dry powder (albeit in conventional doses).1 2 We believe that the child with considerably reduced air entry has difficulty in inhaling single or multiple short sharp doses of salbutamol. The sustained action of nebulised salbutamol allows the child about 10 to 15 minutes of constant inhalation. The dose of the drug may be less important. For this reason spacers and spacehalers have been shown to be as effective as nebulised salbutamol.3 We were interested in the points made by Drs Osborne and Cocksedge in that they have added another clinical method of assessment. However, we would not have counted a child who needed nebulised salbutamol for 24 hours as a responder. We believe that such a child, particularly under the age of 3 years, without a highly motivated general practitioner would still need to be observed in hospital.