Subject: cytokine storm theory follow up

Submitted by: Phil Jacklin, president, Smart Life Forum

 

In the sixth paragraph (Flu Report 2), you come to the question whether the use of corticosteroids or other devices to reduce immune response might suppress the cytokines storm. 

We agree that this is an unresolved question.  However, I would make two comments:

1.  We know cytokines induce an inflammatory response.  They are not just correlated.  That is the function of cytokines.  When not excessive, the inflammatory response is part of the body's defense against injury and infection.

2. The New England Journal of Medicine article I sent you recommends the use of corticosteroids to suppress the inflammatory response - though it too concludes that we still don't know if this is advisable.

I have asthma and in season, I use a powerful inhaled corticosteroid called QVAR.  It is very effective in calming inflammation and as a mucolytic agent.  If I had the bird flu and was suffocating with the mucous in my lungs or if I thought I was headed in that direction, I would use plenty of QVAR. In the absence of good research, I would still feel fairly confident about doing that.  Of course, I might die anyway. 

 

Thanks for the feedback.

 

We know cytokines induce an inflammatory response.  They are not just correlated.  That is the function of cytokines.  When not excessive, the inflammatory response is part of the body's defense against injury and infection.

My concern with this is the research suggesting that one function of cytokines is to kill viruses.

 

I have asthma and in season, I use a powerful inhaled corticosteroid called QVAR.  It is very effective in calming inflammation and as a mucolytic agent.  If I had the bird flu and was suffocating with the mucous in my lungs or if I thought I was headed in that direction, I would use plenty of QVAR. In the absence of good research, I would still feel fairly confident about doing that.  Of course, I might die anyway. 

I don’t have asthma but I have allergies (particularly to cats) and I have found, and research shows, that bioflavonoids and vitamin C are effective at moderating inflammation, as noted in flu report 1. The non-drug approach to reducing inflammation, without suppressing immunity, warrants attention especially insofar as it is more readily accessible to the average person. In the dire scenario you described, I don’t question your decision to employ corticosteroids, though we don’t know for sure whether it would have a net positive or negative effect on survivability.

Thanks for leading the exchange of ideas on this important matter of universal concern.

Rob

P.S. Since you mentioned suffocation, which is usually the ultimate cause of death in cases of bird flu or pneumonia, wouldn’t oxygen be at least as good a treatment as QVAR? It seems we’re not hearing as much about oxygen, in connection with avian flu treatment, as one might expect.