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Monday, May 10, 2010

Advair & Symbicort safe for asthmatics

As you can read here, the FDA has "finally" admitted that long-acting beta Adrenergic mecidines can cause asthma related deaths. I believe this to be a bad admission by the FDA as I explain in my most recent post over at

Don't be Afraid of Using Advair and Symbicort
by Rick Frea, Monday, March 29, 2010
So what's the deal with Advair and Symbicort? These meds have helped so many asthmatics finally gain control of their asthma, yet, with all the recent warnings, the FDA seems to be wary of these meds, and this is scaring people.

Should we be wary and quit taking them? Or, should we continue to use these meds to control asthma? I personally agree with Dr. Matthew Minz that you should fear not. Allow me to explain.
Both Advair and Symbicort contain a Long Acting Beta Adrenergic (LABA) to keep the air passages in your lungs from spasming. In Advair the LABA is Serevent, in Symbicort the LABA is Formoterol.
Some reports say LABAs are linked to worsening asthma and even death, such as this warning about Advair:

"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. "

The most recent FDA recommendation notes this: "LABAs should be used for the shortest duration of time required to achieve control of asthma symptoms and discontinued, if possible, once asthma control is achieved."

So, should we be worried? In a recent blog post, Dr. Minz answers this question best:
"There is very compelling data that shows when asthmatics stop their controller medications, that bad things happen, including ER visits, hospitalizations, and even death."

He's also correct when he writes that fear generated about these meds may actually make things worse for asthmatics, especially if doctors and patients become afraid of these asthma controller meds that have helped many asthmatics gain control of their asthma.

Dr. Mintz also explains that the asthma death rate was increasing steadily until 1996/1997, and then the rate declined for the next decade. The decline started right about the time LABAs were introduced to the market. "Though one can not prove that the decline in asthma death rates are due to the use of LABA's," he writes, "it certainly can not be the case that LABA's cause asthma deaths."
He goes on to make a great case for why FDA Blows it on LABA Safety. A great read if you have time.
This blogger pretty much sums up my view on this matter. He notes how well Advair has helped his wife finally get her asthma under control. Yet, when he heard the latest FDA recommendation, he approached his wife and said, "Advair can lead to asthma-related deaths!"

His wife "lovingly assured" him that, "It gets rid of my symptoms! It makes me feel better! Asthma can lead to asthma-related death! "

I added the bold for emphasis. She is absolutely right: Asthma can lead to asthma- related deaths, and medicines like Advair and Symbicort are PROVEN (as you can see here and here and here) to greatly improve lung function in asthmatics and COPD patients.

Some authors (like this one) actually discuss taking Advair off the market.

Yet, in Europe asthma experts are less wary of LABAs, and even approved of the Symbicort-SMART program that allows asthma patients to use Symbicort as a controller medicine AND a rescue medicine (with a limit of eight puffs per day).

Recently, I wrote how researchers in the U.S. are studying Symbicort use as a "single inhaler" might work for asthmatics in the U.S. too. Although the results of most of the studies are still pending (you can read my post about Symbicort-SMART here).

So, if Advair works so well, and Symbicort is now used as a rescue inhaler in Europe, why all the worry in the U.S?

Well, the FDA likes to err on the side of caution. This can be good, but it also can scare doctors and patients away from meds that work -- like Advair and Symbicort.

I did discuss this with my doctor and he agrees with me. Advair is the first medicine that has fully allowed me to gain complete control of my asthma, and to stop taking it would be foolish. He said, "It's the new asthma miracle drug."

Be educated. I think over-reliance on bronchodilators and LABAs due to poor education is more likely to cause asthma related-deaths than the medicine itself, in most cases. So education is the key. Heed the warnings, yet know the facts.

Advair and Symbicort have been proven to have very minimal side effects so long as you rinse your mouth out after each use. Whenever you take a new medicine, you should always be vigilant for side effects (especially in the first two weeks), and notify your doctor immediately if you spot one.

Likewise, it is very important that you use all your asthma medications exactly as prescribed by your doctor, and follow your asthma action plan to a T. If you don't have an asthma action plan, you should talk to your doctor about creating one at your next appointment.

So, should you continue take your Advair? Definitely. If this is what works to control your asthma and allows you to live a normal life with this disease, don't stop taking it unless you have your doctor's permission.

And if you have uncontrolled asthma, and your doctor recommends you try Advair
r Symbicort, don't be afraid to try it. Just be careful as you would with any other new medicine.
Medicines are only to be used if the benefits outweigh the risks. With both Symbicort and Advair, the benefit is quite often good asthma control and a normal or improved quality of life.

So, as an FDA advisory committee reported back in 2008 (click here), "the benefit of Advair and Symbicort outweighed the risks of adverse effects in adults."

Advair and Symbicort are safe, and they work. Don't be afraid to use them.


Gennarose said...

I was reluctant to go back on an inhaled LABA. I'd been on and off Advair for years and after the whole scare, I decided to go off it permanently. I went on Singulair instead, which worked well, until the worst allergy season I've ever experienced hit me like a truck. I suffered for two months, unable to breath, taking WAY too much of my rescue inhaler, until I became so shakey and exhausted I bit the bullet and went to my physician. She gave me Symbicort in her office. In FIVE MINUTES, I could breathe like a normal human being, and on my way out of the office I repeatedly smacked myself in the forehead as I realized I could have avoided two months of hell.

Anonymous said...

47 mThanks for this post as I read Science Daily and one of their articles is full of fear of taking LABA's. I have been taking Symbicort for 10 years the only thing that help me breath somewhat normally. Last year my specialist suggested to try Advair. I stopped the Symbicort and used Advair. It was 3 weeks of hell and extremely hard to breath, I kept persisting thinking it will kick in. I just had to stop it and go back to Symbicort although it took me another 4 weeks to get back to my normal. As you say if it helps to keep taking it, until they come up with some mircle drug or cure.

Rick Frea said...

Thanks for the comment. My doctor had me do the opposite recently: switch from advair to symbicort. It's been a difficult switch, but at least we have these options to choose from.