Serevent and Foradil carry more risks, and benefits, than other asthma medications

Hi Cher,

Dr. Little gave an excellent summary about Serevent and Foradil and their associated issues. I am an allergist and asthma specialist in the Chicago area and have been treating patients for almost 20 years. I agree with his comments and share his opinion on these two relatively new asthma medications that are now widely used all over the world.

Pharmaceutical companies must provide information to the consumer in a fair and balanced way (the FDA enforces this). This includes any reports (from individual patients as well as studies) that reflect adverse effects. The warning labels on Serevent and Foradil are mostly based on a large study conducted on Serevent a few years ago. The study was called the "SMART" study, which stood for Salmeterol (Serevent) Multicenter Asthma Research Trial. This study comprised over 26,000 patients across the United States. The SMART study is mentioned in the Black Box warnings on Serevent and Advair. I was one of many chief investigators for this study. The study had many flaws regarding conclusions drawn from it subsequently. I won't detail them here.

In short, Serevent and Foradil should almost always be taken with a form of inhaled steroid. Advair and Symbicort are combination inhalers that have inhaled steroid plus Serevent or Foradil respectively. Realize that no studies on Advair (available since 2001) have shown increased risk of asthma related death. I am not aware of any studies on Symbicort showing increased risk of fatal asthma.

The most recent NIH asthma guidelines (updated in 2007) and World Health Organization asthma guidelines promote and support the continued use of long acting beta agonist (Serevent and Foradil) plus inhaled steroid in the management of moderate to severe persistent asthma.

I have found a tremendous advantage to using the combination inhalers (Advair or Symbicort) in many of my patients that fail to respond to low to medium doses of inhaled steroid. The combination of lower doses of inhaled steroid with Serevent or Foradil allows me to reduce the long-term steroid exposure of my patients and as well improve on their asthma control (decrease risk/improve control).

Drug companies must provide warning labels, which is a good thing. Your doctor or specialist should provide you with more detail and explain how the information relates to you. Drug companies chiefly want to sell drugs but must adhere to established FDA guidelines.

Good Luck!

J. Thompson, MD