Here I am again - sooner than I thought - but must discuss something that
just broke here for me in spite of the fact that it, also, is old news but I
think worthy of repeat discussion - I have a family on my list for the past
8 years consisting of 4 asthmatics - the father, age 50, seems to have
solved his problem with his previous GP who gave him Kenacort-R, he
initially stated he used 2-3 times a year, and he just about demanded the
same from me.  I thought that this really wouldn't kill him or put me in
jail considering the frequency so I continued prescribing and he is still
doing fine and is 100% content. Two other family members, boys age 20 and
23, are doing OK on salbuterol and\or salmeterol (use in cycles) and
occasionally need some Theo-Dur as a backup but all in all are OK.  The
youngest, a girl age 17 seemed to be the more problematic.  She did fairly
well on salmeterol for the past 2 years but also needed Theo-Dur on several
occasions.  All in all, no significant problem.
About 10 days ago I was called to their home because the girl was in
broncospasm.  I examined her and to tell you the truth, she wasn't all that
bad considering the times I examined her over the past few years, but, it
became clear that the main problem was that the family was ready to go on
vacation to the mountains in 2 days (Bressanone area - 1600 M) and they were
logically concerned.  The father started pushing his opinion to give her a
shot of Kenacort like he uses, and to tell you the truth, considering all
aspects, I somewhat reluctantly agreed.  Figured she was 17, in good health,
a virgin for steroids, what could go wrong with one shot.  However, when the
girl was confronted with the possibility of a "shot", she went cold, refused
categorically, and demanded something else.  The only thing that came to me
at that time was to give her a short course of deflazacort (what we call
Flantadin or Deflan) 30mg bid for two days and then decreasing doses over
the next 4 days, a total of 6 days of treatment.  She bought that idea since
it was not a "shot", I wrote the prescription and left.  The family went to
the mountains.  The girl did take her medication with good results.  Two
days after she finished her course of therapy and was asymptomatic, she
stayed out late one night fooling around with friends in the piazza (plaza)
until 1:00 AM, probably got a blast of cold mountain air, went to bed to
awaken at 3:00 AM with shortness of breath that continuously worsened and
after about an hour, she died.
Would Kenacort-R have saved her life?

PS - anyone interested in responding can certainly do so to me personally
and not bore members of the list with a subject that was discussed in detail
in the recent past.
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dr. frederick a. deutsch
viale s. lazzaro 114
36100 vicenza (italia)
tel: 0444-562694
email: <[log in to unmask]>
medicina di base, neurologia
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