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2008 Apr 7 - Joint Announcement on Flu Management in South China Morning Post

Drs TAM Cheuk-yin and CHAN Wai-ming of Hong Kong Thoracic Society
Drs Maureen WONG and CHU Chung-ming of American College of Chest Physicians (HK & Macau Chapter)
Letters to the editor, SCMP, 7 APR 2008

As professional bodies of Respiratory Physicians, we appreciate the determination and efforts of the HKSAR government in controlling the recent influenza epidemic. The public is praiseworthy for its willingness to remain vigilant and its adherence to various recommendations from health care professionals. We, as Respiratory Physicians, owe our community a duty of care – to provide the right information. As such, we would like to clarify two recent issues regarding influenza.

Firstly, Tamiflu® (Oseltamivir), an anti-viral against flu A and B, should not be dispensed as an over-the-counter drug. The drug is useful as treatment, pre- and post-exposure prophylaxis for influenza A and B. However, there is evidence to show that liberal use of this drug could lead to emergence of resistant strains. According to the
most recent report from World Health Organization in March 2008 (http://www.who.int/csr/disease/influenza/H1N1ResistanceWeb20080328.pdf), resistance rate of Influenza A (H1N1) to Tamiflu® at Hong Kong is 11%, a rate highest in the Western Pacific Region. WHO had reported resistance to Tamiflu® in flu viruses before, but at a much lower rate – typically < 0.5%. Thus, we want to send a clear message to our community – Tamiflu® should only be prescribed judiciously by adequately trained health care professionals to avoid the emergence of resistance, rendering it ineffective in life threatening situations. Though its efficacy in avian influenza (H5N1) awaits further study, Tamiflu® forms part of the WHO-recommended treatment for this condition. Its efficacy against influenza must be preserved by appropriate usage.

Secondly, balancing the overall benefits and risks, the appropriate use of steroid for treatment of asthma is often life-saving. Irrational fear and misconception of the exaggerated risk of steroid treatment should be dispelled. Patients on inhaled steroid as maintenance therapy for asthma and chronic obstructive pulmonary diseases should continue to follow instructions from their specialists concerning its usage lest an abrupt cessation should lead to an exacerbation of their illness. Systemic steroids may be required for control of exacerbations of these conditions, and prescription with meticulous follow up by qualified healthcare professional is crucial. Friends or foes – steroid can save lives if used judiciously by responsible physicians.

Fight flu and act wisely – we need a bona fide media to disseminate our professional view. As Respiratory Physicians, we will walk with our community as we did in the days of Avian Flu and SARS.