Warning: The following post is meant to make you think, and perhaps give you something to discuss with your doctor. Please do not change your asthma regime without first consulting your physician.
There has been much hype the past several years regarding the safety of long acting bronchodilators such as serevent (which is also a component in Advair) and formoterol (which is also a component in Symbicort). In fact, there was once a threat that the FDA would take this medicine off the market.
Some reports say these medicines are linked to worsening asthma and even death, such as this warning about Advair from MyAsthmaCentral.com:
"University of Iowa researchers have added their voices to growing warnings about Advair, saying that drugs that use salmeterol in combination with an inhaled corticosteroid can make asthma more severe or even fatal."
Or this warning regarding Symbicort:
"Rarely, serious (sometimes fatal) asthma-related breathing problems may occur in people with asthma who are treated with drugs similar to the formoterol in this product (long-acting inhaled beta agonists). "
Studies have been conducted to determine if it is the medicine itself that is causing asthmatics who use it to die? Or is it the fact that these patients are overusing it?
I think these folks are all wrong. I think they are so pent on looking in one direction that they fail to see the big picture. I say this because I do not believe overuse of Serevent is what causes most people to die
I believe what causes most people to die of asthma when they are on Serevent (or a similar such drug) is the fact that instead of seeking help they clutch to the inhaler seeking relief. Instead of controlling their asthma, instead of talking to their doctor or calling an ambulance, they stay home thinking they are going to get "relief" from the inhaler in their hand.
What they lack, really, is proper education.
I can say this because I have had COPD and asthma patients who have overused their Advair or symbicort inhalers. I have accidentally taken extra puffs of mine too, and even while I was a bit nervous about it for a while due to the "scare," nothing happened. My heart never stopped.
I think long-acting bronchodilators do not kill. I think overuse of long-acting bronchodilators does not kill. I think what kills is poor asthma control. What kills is the false belief you are going to get relief from your inhaler when what you should be doing is getting your butt to the ER.
This does not just go for long-acting bronchodilators either. I've seen reports of Ventolin getting a bad rap because some asthmatic dies with the inhaler in his grasp. The report notes: "Asthmatic dies from Ventolin overdose?" Really? You think so?
Back in the 1980s Alupent was deemed such a safe medicine by the FDA that it was made to be legal to sell over the counter. I remember my mom going to get me an inhaler and just grabbing one off the shelf. But shortly after this ruling seven asthmatics died of asthma while clutching their Alupent inhalers. So did poor asthma management get the blame? No! What got the blame was the Alupent. The patient abused the inhaler because it was so easy to get, and soon thereafter Alupent was taken off the shelves.
I'm not proposing that all asthmatics go out and start using their Advair or Symbicort more than they currently do. What I am proposing is that instead of blaming the medicine used to treat asthma, that doctors and scientists and scaremongers spend more time educating asthmatics instead. Let's stop scaring people away from the asthma medicines that work the best, and start educating them how they can manage their asthma and prevent themselves from getting so bad that they'd clutch an inhaler to their deaths in the first place.
For most asthmatics, one puff twice a day of Advair or a similar regime of Symbicort works just fine. For most asthmatics, if you need to use your Ventolin or Xopenex more often than three times in a week your asthma is not controlled, and you need to work with your asthma doctor to get your asthma controlled. You can do it.
Yet there are some asthmatics whose asthma is more severe and who need to use their rescue medicine more frequently. And it's for patients like this who may find a scientifically proven benefit from using medicines like Serevent and Formeterol more frequently. Which is why further open minded studies are relevent.
Yet due to the fear of death and lawsuits American companies fear advancing this research, and the FDA continues to send out warnings that serevent and formoterol are linked to fatal asthma. However, to give the FDA credit, it likes to wait until a medicine beyond a reasonable doubt is safe for patient use.
That said, I have learned that in Britain and Canada Symbicort has been approved to be used not only as a preventative medicine, but as a rescue inhaler. It's called the SMART program. Stay tuned, because next Tuesday I will discuss the SMART program, and discuss whether this, or a similar program, would be good for American asthmatics.