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Robinson et al found no benefit between those who were treated with steroids and those who were not.'" The results of further studies in patients suffering from combined burns and smoke inhalation injury suggest that giving steroids leads to increased mortality and morbidity, mainly because infection occurs more often." 12 Early treatment of smoke inhalation focuses on keeping the upper airways open, and there is evidence that prophylactic upper airways intubation and continuous positive airways pressure ventilation should be carried out in anyone who gives a history of smoke exposure in an enclosed space or who on examination shows facial burns or singed nasal vibrissae or produces carbonaceous sputum."' Fibreoptic bronchoscopy has been recommended as an aid to making an early diagnosis,'4 but this was not performed on our patients. The three month follow up of the survivors suggested that long term physical problems associated with exposure to these fumes are rare. The two asthmatics continued to show evidence of increased bronchial hyperreactivity and required more treatment to control symptoms than previously. A 14 year old girl who was ventilated for only 24 hours developed subglottic stenosis requiring surgical intervention but subsequently recovered. The lung function of the remaining patients was normal with no evidence of appreciable bronchial hyperreactivity. The results of follow up showed a high prevalence of psychological problems, and although we examined only those who were admitted to hospital, this may be a problem for all the survivors." We thank all the staff ofWythenshawe Hospital who helped in responding to the disaster, in particular members of the physiotherapy department and the intensive care unit, and Mr J S Watson of the Regional Burns Unit at Withington Hospital. We thank Mrs S Gleave and Dr J Harrison for help in preparing this manuscript. 6 Clark CJ, Campbell D, Reid WH. Blood carboxyhaemoglobin and cyanide levels in fire survivors. 12 Marshall W, Dimick AR. The natural history of major burns with multiple subsystem failure. airway pressure in the management of inhalation injury in burn victims. "Look out for the point of the cutting diathermy!" said my boss as he handed it to sister. She drove it-into the back of my hand with a nonchalant grace that would have brought tears to Eric Bristow's eyes. It would not have been so bad had it not been a patient with the acquired mmune deficiency syndrome (AIDS) whose lung we were biopsying. …