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Frederick a. Deutsch related his problem with an asthmatic girl and in response to replies added: DE>thanks to all for your comments - sure we use inhaled steroids here in Italy DE>- the fact here was that the girl for many years did well on salbuterol DE>(Ventolin spray) and even better on salmeterol prophylactically - she never DE>presented a need for a more aggressive approach - infrequent attacks in the DE>past were rapidly controlled with theophylline (Theo-Dur caps or syrup) - is DE>the group trying to tell me that it is common practice to put patients on DE>inhaled steroids continuously prophylactically no matter what even if they DE>are asymptomatic for a considerable time - my understanding of the practice DE>here by our pulmonary specialists is that continued use of inhaled steroids DE>is used only for patients rather refractory to salbutamol/salmeterol I must DE>say with no delay. I am fascinated by the difference between practice in Italy and England. In the UK the product licence for Salmeterol (Serevent) says words to the effect that patients should normally be on prophylaxis - and credit to A & H for promoting this aspect, so it seems extraordinary that it should be used so radically differently in Italy. Recent school skiing holiday in Italy also revealed other fascinating differences in medical practice between our countries, when a thirteen year old child had a beautiful colles reduction, but without any anaesthesia at all.. OOOH AAAH Another lad with Anterior Cruciate Ligament injury was told surgery was mandatory, but got a different opinion in UK. The NHS ain't so bad you know! ______________________________________________________________ Dr. David Jobson The Surgery, Main St Surgery Tel +44 (0)1728 830526 Leiston Surgery Fax 832029 Suffolk Home Tel 831100 IP16 4JG email [log in to unmask] * SLMR 2.1a * %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%