In Reply.—I certainly agree with Ring and colleagues that performing a controlled study investigating treatment regimens in laryngotracheobronchitis is most difficult considering the natural variations in this illness. We were interested in observing the acute and long-term (24 to 72 hours) effects of intermittent positive-pressure breathing (IPPB) plus racemic epinephrine hydrochloride and therefore established fairly rigid criteria such as a fixed number of treatments. The suggestion by Ring et al that the patients "were deprived of the full benefit of these treatments" assumes that this form of treatment has already been proved effective. They missed the main point of the article, which was not to assume the value of the treatment regimen but to prove, in a controlled manner, its efficacy, if any.
Although patient 5 of the treatment group had only a score of 9 during the first six hours, this patient's condition deteriorated subsequently (patients were not