We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Bronchodilator Safety in Chronic Obstructive Pulmonary Disease—Reply

Matthew B. Stanbrook, MD, PhD1,3,4,5; Michael Campitelli, MPH3; Andrea Gershon, MD, MSc2,3,4,5
[+] Author Affiliations
1Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
2Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
4Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2014;174(4):648. doi:10.1001/jamainternmed.2013.12684.
Text Size: A A A
Published online


In Reply We thank Drs van Dijk and Käyser for their thoughtful comments on our study. They argue that our study design may be prone to residual confounding, despite our use of sophisticated methods to control for this. We agree and said so in our article.1 However, randomized trials are also prone to methodological limitations, particularly when attempting to assess harms of therapy, which observational studies can overcome. Specifically, randomized trials often exclude participants with comorbidities or demographic characteristics that would place them at increased risk of adverse events, even when such characteristics are common among patients who in clinical practice will go on to receive the treatments being evaluated. Also, as serious adverse events are typically infrequent and often unexpected, randomized trials commonly lack sufficient power to identify them adequately.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





April 1, 2014
Wouter D. van Dijk, MD, PhD; Sabine C. Käyser, MD
1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
JAMA Intern Med. 2014;174(4):647. doi:10.1001/jamainternmed.2013.12708.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...