A panel of federal drug experts voted on Thursday that the drugs Serevent and Foradil should be banned from use in the treatment of asthma, but the experts said that Advair and Symbicort, which together are far more popular, should continue to be used.
Advair contains Serevent and a steroid. Symbicort contains Foradil and a steroid.
Doctors face difficult choices with children whose asthma remains uncontrolled with low-dose steroid treatment. If they increase the steroid dose, the risks include stunted growth, acne, greater vulnerability to infections and changes to skin, eyes and bone. If they add a long-acting beta agonist, the risk of death, although small, increases.
The beta agonists, by relaxing bronchial spasms, treat mild symptoms and make patients feel better immediately. Feeling better, these patients may decide against taking the steroids since steroids have few immediate benefits. Indeed, patients prescribed both drugs separately get fewer refills of the steroid than of the beta agonists. Such patients leave themselves vulnerable to severe attacks and death.
This information is hardly new. SimulConsult’s Michael Segal MD PhD has been warning about these drugs at least since his 1992 letter to the New England Journal of Medicine. His guide to asthma is essential reading.
It will be interesting to see if Obama’s proposed Comparative Effectiveness Institute or the FDA’s Sentinel Initiative tackles issues like this one. It hasn’t been in any manufacturer’s interest to study this issue and so there’s been little attention paid to it despite the warning signs.