Any effective COPD respiratory care pathway should allow for patients to be referred to appropriate psychological support services. Complementary therapies as the name suggests, are treatments which complement or work together with more mainstream therapies. If you are thinking about using a complementary therapy you should always discuss it with your doctor or nurse first and keep taking your prescribed medication.

There was some confusion at one point in his evidence as to when he thought the guidelines were published but it is clear from his evidence in chief that he was aware that the guidelines were written in 1995 and published in February 1997 and that he received the publication some time after that, perhaps March 1997. He was asked if he was using that as a guide to the dosages that he was prescribing for Emma and he replied, “Yes, that without question had an effect on management”. However, I noted that Dr Howatson also said that he had never actually seen a child with adrenal suppression due to inhaled steroid therapy for asthma in 15 years of carrying out paediatric post-mortems although he had seen adrenal suppression with oral steroids, which was quite commonly understood. In spite of Emma’s atypical presentation, Dr Howatson believed that adrenal suppression was responsible for Emma’s death and he said that if she had not been adrenally suppressed she would still be alive.


Dr Donaldson said that Emma’s death could and should have been prevented and that this was more of a reflection on the medical profession than on any individual practitioner. Mr Lindsay for MHRA said that there was no merit in Dr Cochran’s criticisms regarding the absence of footnotes in the May 1998 article in Current Problems in Pharmaco Vigilance, given that it is common for requests to be made by medical practitioners to the Post Licensing Division of MHRA for further information. I noted that in his evidence Dr Howatson said that the Registrar General had received notification of the change of the cause of death from “unascertained” and that this had been registered. Mr Frame said that he was aware that a recommendation had been made that the the cause of death should be amended but said that the family had never actually had an amended death certificate.

The reasons are being studied but it seems your genetic make-up can play a part, as can the influence of your environment. Seem to be ordinary flu-like infections, from which some people don’t recover in the normal way. Around 30% of people in England have high blood pressure but many don’t know it. If left untreated, high blood pressure increases your risk of a heart attack or stroke.

Side effects of Anabolics

Any child receiving high dose inhaled corticosteroid therapy in whom adrenal suppression and crisis is suspected should be referred for urgent medical assessment in hospital. Prolonged treatment with high doses of inhaled corticosteroids, particularly higher than recommended doses, may result in clinically significant adrenal suppression. It is recommended that the height of children receiving prolonged treatment with inhaled or nasal corticosteroids is regularly monitored.

He said that there was a risk that a viral encephalopathy may have been missed because areas where lesions etc might have been may not have been examined. Emma’s father, Stewart Frame, told the inquiry that he and his wife were telephoned by, he believed, a police officer and were told that it had not been possible to establish the cause of Emma’s death. Emma’s parents were given the option of accepting the post-mortem results, having Emma’s body retained for further examination or having Emma’s brain removed for further investigation, which could take six weeks. Mr and Mrs Frame understood that the procurator fiscal was satisfied that no further investigation was required and that the question as to whether there should be any further investigation was left to them to decide.

Dr Cochran said that he discussed this article with colleagues because ‘obviously one it concerned when advice from a national body seems to be contrary to one’s own understanding of the evidence at the time’. He said that everyone he spoke to in the field agreed that there was no evidence to justify the statement relating to clinically important systemic effects occurring at licensed doses of inhaled corticosteroids, again due to there being no evidence of this occurring at the time that the bulletin was published. Accordingly, he considered that there was no reason for him to change his prescribing policy.

Effects of fatigue

Evidence was given to the inquiry regarding the delay in the issue of a first appointment for Emma and the lack of a specialist follow-up appoiintment for Calum. However, it does not seem to me, from the evidence which was before the inquiry and for the reasons set out previously, that the terms of the bulletin were sufficiently robust or comprehensive. Dr Suvarna said that practitioners should be familiar with the licence conditions of medications, which are summarised in the BNF but said that they were not required to refer to the SPCs on a regular basis.

For people with other health conditions, pneumonia can sometimes be severe and may need to be treated in hospital. Physiotherapy, speech and language and occupational therapy can also help. Surgery may also be an option for some people whose symptoms have stopped responding to medication. Many people will eventually be cured of their OCD, or their symptoms will at least be reduced enough that they can enjoy a good quality of life.