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Frederick 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 >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. I think this is of general interest. I may be sticking my neck out but my quick response is NO. I suspect that Kenacort-R would only have given low levels of steroid that might not have been enough to clear the asthma at all. And even though she stopped the oral steroids 2 days previously, the half life of these things is generally long (36 hours for prednisolone). Therefore the residual steroid at the time of death may well have been greater than if she had had the depot injection. Additionally, is there a factor "X" here? Doug Jenkinson, Keyworth, Nottingham. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%