Mainstream media ran with the headlines banning certain asthma medications, confusing many patients.
The bottom line is that long-acting beta agonists alone, like Serevent, are no longer indicated for asthma. Those combined with an inhaled steroid, like Advair and Symbicort, remain safe.
Patients however, are confused, as internist Matthew Mintz cites an example where “one patient whose previously poorly controlled asthma was improved with Advair, but stopped because of an article she read in Men’s Health Magazine.”
He goes a step further and wants the FDA to remove the warning pertaining to Advair and Symbicort, which will be “the only way to reassure doctors, patients, critics and the media” about the safety of these medications.
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- Why does my new asthma inhaler suck? Questions surrounding the CFC to HFA inhaler transition
- Texting young liver transplant patients to take their medications
- Are generic medications as good as their brand name counterparts?
- Cheap asthma treatment using a homemade spacer
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I don’t find the arguments very convincing. According to 2 Cochrane Systematic Reviews, long-acting beta2-agonist inhalers give a higher risk of serious side events, even when used together with corticosteroids. See the last cochrane review about formoterol: http://is.gd/bCmh. Coincidentally I posted the podcast of this review on my blog yesterday: http://is.gd/bCo6.
The conclusion of the Cochrane authors is to keep using combinations if patients feel it helps (because there is just a small increase of risk), but to discuss the discontinuation in case of no benefit. Thus in the case of Mathew’s patients, the patient should be advised to continue taking Advair.
I have a child with asthma (hospitalized 3 days), who controls her asthma very well by taking corticosteroids in the mite-season and beta-2 agonists when needed. I’m glad we can keep the medication to a minimum while keeping the asthma under control.
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