Serevent and Foradil: Why Aren’t They Worried About COPD’ers?

My understanding of the debate about the bronchodilators, salmeterol (Serevent) and formoterol (Foradil) and the 2 combination drugs that contain them (Advair/Symbicort), is that the concern was raised when people taking salmeterol were found to have a higher risk of death from asthma. At the time the study findings came out, the conclusion was that this drug and anything that contained it were harmful in some way. This is why the black box warning was applied to all of these drugs.

However, subsequent studies suggested that the problem was not really the drugs themselves. Instead, the real problem seemed to be that a broncodilator alone is just not an effective treatment for asthma. Given the inflammation you reference in this post that is standard with asthma (but not necessarily with COPD), experts now recommend that people with asthma get an inhaled steroid along with the bronchodilator. This is the reason why Advair and Symbicort were developed in the first place, after all.

But for people with COPD, who do not tend to have the same degree of inflammation/immune system involvement, the need for inhaled steroids may not be as great. Hence the fact that a bronchodilator alone may be a safe and effective treatment. The fact that the FDA continued to approve these drugs for COPD is rooted in that fact, not in a lack of caring about COPDers. At least that's how I see it.