Many asthmatics respond to a sensation of breathlessness which is not well
correlated with lung function. Hyperventilation, is a part of this but not
the whole story (I'm sure there are biomechanical, cognitive and behavioural
elements). If he's "breathless" and his inhaler means he gets less
breathless but we don't understand why should we blame him?
LA beta-agonists sometimes help (could he be sensitive to degrees of
b-constiriction which we just can't measure?) as might breathing training if
he can stand Russian abuse and lay his hands on £300.
I suspect people take inh steroids only if they percieve them as working and
worth the risk of SEs. We may see risks of disease > adverse effects, but
that's just our perspective.
Chris
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Stephen Parkinson
> Sent: 19 December 1998 09:29
> To: [log in to unmask]
> Subject: Duovent overuse
>
>
> I have just seen a patient who is using one Duovent inhaler a week. This
> means about thirty puffs a day. He has done so for many years
> and has been
> removed from one Doctors list because of this.
>
> His excuses for not attending local Chest Clinics and the Brompton range
> from the good, e.g. being in prison, to the not so good, e.g. never
> recieved a letter, however he has failed to attend any follow up. He has
> been admitted to hospital suffering asthma attacks on at least two
> ocasions. He uses Budesonide at a reasonable rate. He always has normal
> peak flows in the surgery. Inhaler technique is excellent (all that
> practice I suppose).
>
> Obviously something is going on.
>
> Does anyone know what? I find it difficult to imagine Duovent is a drug of
> abuse or has any value on the black market. What should I do? Has anyone
> else seen a patient like this?
>
> Stephen Parkinson
>
>
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