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For people with long-term illnesses, Foradil and Serevent are more of the same

December 15, 2008

by keito

The news broke on Thursday, December 11th, that an FDA advisory panel had given the inhalers Foradil and Serevent a death sentence.  The panel recommended that both drugs no longer be used in the treatment of asthma, while Advair and the more recent Symbicort, an inhaler that uses the same principal as Advair for treatment but with different drugs, were given the okay.

I have used three out of four of these medications.

I started being treated for asthma about twelve years ago, and the guesswork and trial-and-error process that goes into finding the right inhaler can be, often literally, dizzying.  After realizing I was one of those people who can’t tolerate albuterol, the typical fast-acting asthma treatment, I briefly tried an asthma medicine in a pill that is ground up inside the inhaler immediately before inhalation (which was just as ridiculous as it sounds), and a whole slew of other pharmaceutical inventions.

I landed on Advair almost ten years ago, at which time my pulmonologist assured me that it was “the latest technology.”  It was the latest and greatest because it combines two ingredients for improved treatment: a long-acting beta agonist (LABA) and a corticosteroid for reduction of airway inflammation.  It was this combination which caused Advair, along with Symbicort, to get continued approval from the FDA advisory panel.

Stick with only one ingredient, however, and you have an apparent increased risk of a “catastrophic” asthma attack, as the NBC Nightly News called it, the warning signs of which might be masked by the airway-relaxant beta agonist.  In a nutshell, using only the one type of medicine found in Foradil and Serevent is bad news.

Even if you’re not one of the more than 17 million Americans being treated for asthma (a figure taken from the American Academy of Allergy Asthma and Immunology website), the news about Foradil and Serevent affects us all, and, sadly, is typical besides.  Drugs get recalled and new side effects are found for them on a fairly regular basis, and some of those side effects have been notably fatal.

Anybody with Type-II diabetes in their family probably remembers the recall of Rezulin in 2000.  Rezulin was supposed to be a premier treatment for Type-II diabetes, but what it’s most remembered for is the liver damage it caused, leading to liver failure and death in many patients.  A Rezulin Newsletter ( states that Warner-Lambert, who produced the drug, knew in 1993 that it could cause liver damage, and yet it was approved by the FDA in 1997 and would last another three years on the market.

Even thoroughly evaluated medications aren’t always safe.  Advair, given the thumbs up by the FDA panel, has long carried the warning that “in patients with asthma, medicines like salmeterol [one of the two ingredients in Advair] may increase the chance of asthma-related death. So ADVAIR is not for people whose asthma is well controlled on another controller medicine.”

Symbicort’s website is similarly cheerful with its potential side effect-of-death disclaimer: “SYMBICORT contains formoterol, a long-acting beta2-agonist (LABA). Medicines containing LABAs may increase the chance of asthma-related death. So, SYMBICORT should be used only if your health care professional decides another asthma-controller medicine alone does not control your asthma or you need two controller medicines.” (See and for the full disclaimers.)

These inhalers have the same story as all other drugs: anyone considering taking a drug, or getting a vaccine, has a responsibility to themselves to read up on it and weigh the risks versus the benefits.

The trouble is that’s awfully hard to do when you don’t know what those risks might be.

When it comes to new things, it’s important to remember that the pharmaceutical companies aren’t always looking out for you, and even the FDA might not have your back.  As Foradil and Serevent have shown, no medication, no matter how long it’s been on the market, is guaranteed.

I’ll finish with an apt quote from A Rezulin Newsletter:

“Public Citizen director, Dr. Sidney Wolfe, finds Rezulin to be an example of the dangerous practice the FDA uses of ‘approving drugs too readily and waiting too long to remove them. It makes some people lose faith in the FDA. It also winds up killing a lot of people that wouldn’t have been killed had the drugs not been put on the market in the first place.'”

Put it that way and Thursday’s announcement hardly seems like news at all.


The American Academy of Allergy Asthma and Immunology for basic information on asthma

AstraZeneca responds to FDA Joint Advisory Committees’ recommendation on SYMBICORT® linked through the website for the inhaler

FDA advisers: Restrict some asthma drugs (Associated Press)

Finding Alternatives to the Food and Drug Administration by Richard E. Ralston, Executive Director of Americans for Free Choice in Medicine, featured in Capitalism Magazine (September 21, 2006)

  1. Nuejam permalink
    December 15, 2008 1:32 pm

    In the wake of the stock market crash it would be great if we cast the scientific aura of infallibility off of the pharmaceutical industry.

    Asthma medicine sounds like it has a really screwy history. So does BiDil, a heart failure prevention medicine for blacks. Fiddling with statistics made the historical economic and nutritional history of some black populations seem genetic, but the effectiveness of BiDil in blacks is not constant across diverse black populations, nor is it any different between whites and blacks over 63 years of age.

    What are the homeopathic options for Asthma?

  2. keito permalink*
    December 16, 2008 2:48 pm

    I really believe that anybody acquainted with a long-term illness in some way learns very quickly that pharmaceutical companies aren’t infallible–or even if you watch the news. Again, it really is more of the same.

    Corticosteroid drugs really seem to be an effective treatment for asthma, and they come in a lot of different forms. I feel like it’s just necessary to find the one that you can tolerate well (not everybody gets a lot of side effects from medicines like I do anyway). Even mild asthma can result in a fatal attack so it’s important to make sure it’s well-controlled with an inhaler. There are some negatives to an inhaled steroid, of course, like decreased calcium absorption, but the benefits usually outweigh the risks. Also, I take a calcium supplement every day and I will get regular bone density checks after a certain age to compensate. My inhaler really helps me a lot, so the negatives are almost a non-issue and it’s something my doctor (and I) will keep an eye on.

    As far as homeopathic options, someone once told me she improved her asthma by cutting dairy out of her diet, but it probably helped because she really had an allergy (hasn’t done anything for me). Doctors have told me (and I agree) that one of the worst things you can do for asthma is stop exercising. Even if the patient can only manage strength-building exercises like small weights or yoga it really helps a lot, because your muscles and body will use oxygen more efficiently and it makes daily activities easier.

    There are a lot of things an asthma patient can do to help themselves without medicine: regular cleaning of your living environment (especially where you sleep); removing dust-catchers; not using potential allergens like perfumes or down pillows; and not burning candles (scented are supposed to be the worst because they produce more soot). Those little things can also help a lot. And wear a mask when dusting to avoid inhaling the stirred up dust! An air cleaner in the bedroom is also a great option.

    Homeopathic/non-pharmaceutical options are more to help with and supplement treatment, however. The main objective with asthma is to control it as much as possible, keep doing your thing and keep out of the hospital, so I think that includes finding a good controller medicine, keeping up the exercise and eliminating as many allergens/triggers as possible from your living environment.

  3. April 29, 2009 12:12 am

    Great post! Just wanted to let you know you have a new subscriber- me!

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