 |
 |
In message <[log in to unmask]> "dr. frederick a. deutsch" wrote: > - 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. The British Thoracic Society (BTS) guidelines *currently* recommend the use of salmeterol only in patients on regular inhaled steroids. The practice in the UK is to have a low threshold in prescribing these drugs. Salmeterol is used in patients refractory to inhaled steroids. The perception is that inhaled steroids are inherently safe, though a number of groups are actively studying the effects of prolonged use (including Prof. Tattersfield at the City Hospital, Nottingham) particularly with regard to bone metabolism and effects on children. Before anyone launches a didactic reply based on BTS guidelines, please bear in mind they are not immutable. I gather that the next iteration will provide for an increasing role for the use of salmeterol and may also promote the use of fluticasone which, allegedly, has fewer systemic effects than "conventional" steroids. As an aside, it has been estimated that wholesale transfer of patients from beclomethasone etc. to fluticasone would cost the NHS in excess of 100 million pounds (!) Trims. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%