Frederick Deutsch :
>thanks to all for your comments - sure we use inhaled steroids here in Italy
>- the fact here was that the girl for many years did well on salbuterol
>(Ventolin spray) and even better on salmeterol prophylactically - she never
>presented a need for a more aggressive approach - infrequent attatcks in the
>past were rapidly controlled with theophyline (Theo-Dur caps or syrup) - is
>the group trying to tell me that it is common practice to put patients on
>inhaled steroids continuously prophylactically no matter what even if they
>are asymptomatic for a considerable time - my understanding of the practice
>here by our pulmonary specialists is that continued use of inhaled steroids
>is used only for patients rather refractory to salbutamol/salmeterol I must
>say with no delay.
Who needs prophylaxis with inhaled steroids?
The increasingly accepted "rule of thumb" in the UK is patients
who use a bronchodilator three times a week or more. Some, however,
may not improve on steroids, and the benefits of maintaining them
on them would be arguable. I am not sure whether your patient
would have fallen into this category, but over here we would not describe
salmeterol as being used "prophylactically", this term being reserved for
anti-inflammatory agents only. Even so, to the best of my knowledge
there is no evidence that inhaled steroids prevent deaths. That
benefit is attributed to systemic steroids.
Doug Jenkinson, Keyworth, Nottingham.
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