At 21:26 08/08/96 DST, dr. frederick a. deutsch wrote:
>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
V big snip
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.
This tragic tale must be repeated thousands of times every year all over the
world. The main lesson might be that lessons generally (but not
universally) learned in one country are not yet learned in others just a
short plane ride away. The mailing makes no mention of inhaled
corticosteroids, which surely most UK doctors would have been prescribing
for years for this family. Are they not available or not fashionable in
Italy? British Thoracic Society guidelines may not be perfect, but perhaps
they should be exported to everyone in the English speaking world and
translated for everyone else.
On one night in my training practice about 13 years ago, the partner on duty
had two asthmatic patients die, virtually in front of him. Despite the many
people who quote gloomy statistics about UK asthma deaths the number of
patients under 45 years of age who die from asthma each year in this country
is now well under 1000.
Fewer and fewer doctors have to cope with the aftermath of this kind of
tragedy. Kenacort-R which I presume is an injectable steroid may or may not
have saved this 17 year old's life. Maybe nothing would have saved her
life. But regular inhaled steroids, supplemented where necessary with oral
steroids have reduced morbidity, hospital admissions and even out of hours
calls in my practice and thousands of others in the UK. Whether their
increasing use is responsible for the gradually decreasing mortality,
especially in younger people, is hard to prove statistically, but impossible
to doubt personally.
If this tragedy helps to get inhaled steroids into widespread use in Italy
perhaps a young girl's death will not have been totally in vain.
Julian Bradley
GP, GP tutor, MAAG chairman (and father of asthmatic son)
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