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Electronic Letters to:

Occasional reviews: S A McKenzie and A Bush Difficult asthma in children Thorax 2002; 57: 915-916 [Abstract] [Full text] [PDF]

Electronic letters published:

Re: Medication compliance and difficult-to-treat asthma

Andrew Bush, S.A.McKenzie   (21 December 2002)

Medication compliance and difficult-to-treat asthma

SK Agarwal   (12 December 2002)

Re: Medication compliance and difficult-to-treat asthma 21 December 2002
Andrew Bush, Paediatrician Royal Brompton Hospital, S.A.McKenzie Send letter to journal: Re: Re: Medication compliance and difficult-to-treat asthma a.bush{at}rbh.nthames.nhs.uk Andrew Bush, et al.	Dear Editor We thank Dr Agarwal for responding to our article. We agree that the commonest cause of steroid resistant asthma is failure to take the prescribed steroids. However, there are perhaps more diagnostic aids than is acknoweldged. Compliance can be taken out of the equation by doing a therapeutic trial of a single intramuscular injection of depot triamcinolone.[1-4] If asthma persists, then it can truly be said to be steroid resistant. Alternatively, measuring serum prednisolone and cortisol levels may also be illuminating, if the child is supposedly taking oral steroids. References (1) Veeraraghavan S, Sharma OP. Parenteral triamcinolone acetonide: an alternative corticosteroid for the treatment of asthma. Curr Opin Pulm Med 1998;4:31-5. (2) McLeod DT, Capewell SJ, Law J, MacLaren W, Seaton A. Intramuscular triamcinolone acetonide in chronic severe asthma. Thorax 1985;40:840-5.  (3) Willey RF, Fergusson RJ, Godden DJ, Crompton GK, Grant IW. Comparison of oral prednisolone and intramuscular depot triamcinolone in patients with severe chronic asthma. Thorax 1984;39:340-4. (4) Ogirala RG, Aldrich TK, Prezant DJ, Sinnett MJ, Enden JB, Williams MH Jr. High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. N Engl J Med 1991;324:585-9.
Medication compliance and difficult-to-treat asthma 12 December 2002
SK Agarwal, Head, Department of Chest Diseases Institute of Medical Sciences, BHU, Varanasi Send letter to journal: Re: Medication compliance and difficult-to-treat asthma sk_agarwal{at}satyam.net.in SK Agarwal	Dear Editor Medication compliance in asthma is disappointingly low and leads to poor asthma control in children. It is very common that parents do not supervise treatment and often report poor asthma control. Many difficult-to-manage asthmatics have ongoing exposure to allergens or other asthma triggers. In such instances, required medication may be very high and the results may be disappointing. Only 30% of pediatric asthmatics, age 7 to 15, have optimal environmental control at home. Children who are nonadherent to both medications and environmental control measures can be challenging to manage. Despite the fact that many immunologic abnormalities have been identified, there is no laboratory test that can be used in making the diagnosis of steroid-resistant asthma. As a result the diagnosis of steroid-resistant asthma remains a clinical one.