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

  • Last month the FDA (Food and Drug Administration) voted unanimously that the benefit of Advair and Symbicort outweighed the risks of adverse effects in adults. This, following concerns about reports of adverse effects, even death, associated with these inhalers.


    That's great news for the people who take these medicines and are breathing much better because of it. It's comforting news for people with asthma, but what about those with COPD? If you have COPD and are taking Advair or Symbicort, or Serevent or Foradil alone, not combined with Flovent or Pulmicort, should you be worried?


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    Clearing the Air

    First, let's make sure we understand what medicines we're talking about and what's in them. The medications of interest were LABA's (long-acting beta agonists) prescribed for treatment of asthma, which include:

    Serevent (salmeterol, a LABA) taken alone

    Foradil (formoterol, a LABA) taken alone

    Advair (a combination of fluticasone (Flovent, an anti-inflammatory) and salmeterol (Serevent) 

    Symbicort (a combination of budesonide (Pulmicort, an anti-inflammatory) and formoterol (Foradil)


    Difference Groups, Different Ages, Different Needs

    When it comes to medication one size definitely does not fit all. And even though many medicines work well for adults and children with asthma as well as adults with COPD, there are differences in the nature of these two disorders that call for careful consideration in prescribing these meds.


    Here's the breakdown of conclusions from the panel:


    • For children age 12-18 years: Benefits outweighed risks for both Advair and Symbicort.


    • For children age 4-11: Advair was approved for use, but by a narrow margin. Symbicort was not approved for this age group.


    • Adults with COPD: The FDA Advisory committee did not focus on the use of Serevent or Advair in COPD, only asthma. Both Advair and Serevent continue to be approved for COPD.



    So, What's the Difference?

    Although asthma and COPD have similarities, we must note that asthma has a higher component of inflammation (swelling) of the airways than COPD. That's why it's important to have that anti-inflammatory corticosteroid medication along with the Serevent and Foradil.


    LABA's do not have any anti-inflammatory properties. Furthermore, LABA'S such as formoterol may actually lessen the white blood cell response in asthmatics. Keep in mind that although anti-inflammatory corticosteroids remain the cornerstone for controlling mild and moderate asthma, when used in higher doses for moderate-to-severe asthma they may cause long-term adverse effects, including osteoporosis and glaucoma. This is why a course of therapy should consider the combination ICS+LABA or ICS+antileukotrienes (Singulair, Accolate and Zyflo).


    A Word About Health Reports and New Findings

    In my article "New Study Finds..." I provide some guidelines on what to do and what not to do when you read or hear health research reports.


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    Here are a few other things to think about. Sudden deaths among asthmatics clutching their inhalers have added to the debate about LABA inhalers. But trying to determine whether the deaths were caused by lung disease or the inhalers has proved difficult. Consider this: If you find a person who is deceased, clutching a bottle of tranquilizers, would that cause you to consider taking that medication off the market? Probably not. Overdose of a perfectly safe medication can cause death.


    Education is the Key

    People found in critical condition, even dead, having just taken inhaled medications occurs far more often than you might think. Oddly enough, some people don't consider inhaled medications to be "real" medicines. But they are real, indeed, and they're powerful, and their potency must be respected just like any other medicine. Proper education is so important when it comes to inhaled medications, and it assures the greatest benefits and fewest adverse effects possible.  


    Jane M. Martin is a respiratory therapist, author, and teacher, and the director of Breathing Better Living


Published On: January 24, 2009