The cholinesterase inhibitor drug pyridostigmine can be used prophylactically against some chemical warfare agents. In a previous article in Military Medicine, authors reported exacerbations of symptoms among asthmatic volunteers given pyridostigmine, but no change in objective pulmonary function (forced vital capacity = FVC), and the authors suspected that “exacerbation of asthma symptoms could have been due to a placebo effect”. We provide a re-analysis of the original data in a mixed effect model and show that pyridostigmine caused FVC to decrease by 6.8 [2.8, 10.9] percentage-points of predicted among asthmatics, but not in healthy subjects. Caution is warranted before administering pyridostigmine to asthmatics.

Author's note: This abstract is not included in the published paper.