While it is important to know the degree of increases in WBC counts, it is just as important to be able to appropriately assess the WBC differential, so as to avoid missing a treatable condition. The above increases in neutrophils are made up by a small portion of immature (bands) WBC that predominately came from the bone marrow. However, this contribution of bands does not usually cause the same degree of a "left shift" that is normally associated with presence of a bacterial In addition, glucocorticoid induced leukocytosis is generally not associated with increases in temperature or worsening in the condition that is being appropriately treated. Therefore, it is important for the clinician to put all of these factors in context when assessing, monitoring and treating the patient's medical condition.
I want to say as an RT I really enjoyed and appreciated this article. I also am very happy that you said MDI’s are just as effective as aerosol’s, I agree whole heartedly. I must say though in my experience I often get complaints from patients that say their MDI’s do not work for them. When I ask them if they are taking them with a spacer I get the the blank stare. It’s important to educate the patient on how to properly take their MDI as after proper teaching and spacer administration they are like “oh wow this does work. I’ve been taking inhalers for years and nobody has told to me about this”. I know our docs always write the rx for spacer and MDI but after talking to pharmacy personnel I found out that they do not carry spacers and only give the patient the MDI. It has now become habit at our hospital that if the patient is to take MDI’s we get an order for MDI and spacer teaching, this way the patient receives a spacer from the therapist and proper education. Thanks again for writing the article.