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Tuesday, January 26, 2010

Advair/Symbicort: Is overuse really dangerous???

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

"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.


Erika said...

I agree with you 100 percent. I am convinced the people who die while on Advair or Symbicort are people who don't understand the difference between long-acting maintenance medication and short-acting rescue inhalers. They get tight, they take the wrong thing for the situation, things get worse.

I am a long-time, well educated asthmatic who takes Advair among a combination of other asthma and allergy drugs. I have failed on everything else I tried, including Symbicort. The day they take Advair off the market, I am going to be one unhappy (and SICK) puppy.

I love your blog, by the way.

Jaime said...

I am wondering if this increased risk of death while on Symbicort or Advair is beacause if you are on one of these and run out or miss a dose, conditions usually deteriorate VERY quickly. I have used Symbicort for a couple years now, and was on Advair before that. If I run out and can't get my Rx filled right away, I am in trouble. Being without it for 2 days has sent me to the hospital. Just a thought.

Anonymous said...

What bothers me is that you're sucking in dry powder. Tell me... what tests have been done to determine what affects dry powder inhalers have on the lung's ability to process oxygen? Who is so God-Like that he/she can assume
dry powder inhalers are the best on the market and don't pose a risk, wether short-term or long-term? I seriously doubt anyone is overusing their inhaler. You actually believe and promote the idea that doctors just throw the inhaler at the patient and tell them to use it as they see fit to? When I read blogs such as yours I wonder if you're not supported by a pharmaceutical company... maybe free advair, etc.

steve said...

I used ventolin for years. My athsma was really bad and the preventative I had did very little (I forget the name now) which of course made me very reliant on ventolin and I believe this was the cause that made my athsma worse. The doctor recommended Symbicort recently and I have had such a success with this medicine that I no longer use the emergency medication at all.

I hope that what you say is true, I will continue using this medicine as the reports are based on people who misuse their medication which I think rings true. There are many treatments for Athsma and the trick is finding the medication that works for you and not over use one medication as it makes it worse.