Friday, December 30, 2005

Are long-acting beta agonists (LABAs) safe. I've argued in the past that they are, but now a perspective piece in the NEJM argues that they are not. (Inexplicably, it is not available as free fulltext. If you are going to publish editorials on controversial, life-threatening topics, I think you should make them available to people).

Fernando Martinez, a respected asthma researcher and participant in the FDA panel discussion about LABAs presents some new data and argues they should be used only as a last resort.
Dr. Gault wrote:
It has been the experience of pulmonary docs and allergists that for most patients the addition of a LABA to ICS is beneficial yet there may well be the possibility of a rare serious side effect.
Both doctors admit that there may be something to this issue, but, at the same time, indicate that patients and treating physicians have recognized clinical improvement in patients when ICS/LABA meds were added. Perhaps this will end up being like the Vioxx issue, where a few people are adversely affected by a drug while a great number are helped. How many people are worse off now that Vioxx has been removed from the market? How many people will see their asthma control suffer if Advair is removed from the market?