Wednesday, June 14, 2006

Long Overdue Post on "Deadly Asthma Inhalers"

I've been meaning to post this for a week! From HealthDay, June 8:

THURSDAY, June 8 (HealthDay News) -- Adding to the ongoing controversy over a popular class of asthma inhaler medications, a new data review suggests the drugs may be dangerous.
Compared to placebo, the "long-acting beta-agonist bronchodilator" inhalers (which include Serevent and Advair) more than tripled users' risk of asthma-linked death, according to the report. Risks of hospitalization and life-threatening complications also went up.

"These agents should not be used," concluded lead author Dr. Shelley Salpeter, a clinical professor of medicine at Stanford University and a physician at Santa Clara Valley Medical Center in San Jose, Calif.

However, another doctor said the drugs are still safe enough to use -- although they should be prescribed carefully.

Long-acting beta-agonist bronchodilators are designed to help relax airway muscles and improve breathing. They include popular medications such as Serevent (salmeterol) and Advair (which combines salmeterol with a steroid). The drugs are reportedly expected to gross nearly $7 billion in sales to consumers this year.

Another family of bronchodilators, called inhaled anticholinergics, are "very safe and effective," Salpeter said. But long-acting beta-agonist drugs have been controversial. Last year, the U.S.
Food and Drug Administration issued a warning that the drugs could worsen symptoms and even lead to death.

In the new report, Salpeter and colleagues launched a broad review, or "meta-analysis," examining the results of 19 asthma drug studies involving nearly 34,000 participants.
The findings are expected to appear in the July 4 issue of the Annals of Internal Medicine.
The experts found that, compared to placebo, long-acting beta-agonists boosted the risk of asthma-related hospitalization by 2.6 times and the risk of life-threatening complications by 1.8 times.

The risk of death rose by 3.5 times, although the researchers caution that the very small number of deaths recorded in the studies limits the "reliability" of that number. Even so, the findings suggest that salmeterol could be responsible for 4,000 of the annual 5,000 asthma deaths in the United States, the study authors said.
"The take-home message is that long-acting beta-agonists worsen asthma control and increase the risk for moderate asthma exacerbations, life-threatening asthma exacerbations and asthma deaths," Salpeter said. "These can occur without any warning from increased symptoms, which make them especially dangerous," he added.

Not so fast, said the author of a commentary accompanying the report findings.
While they have dangers, the drugs can still "be helpful to some people," said Dr. Jeffrey Glassroth, professor of medicine at Tufts University in Boston.

If the drugs weren't used, "we might prevent some adverse reactions, but we might create as many, or even more, problems in our asthmatic population," Glassroth said. "What I would like to see is more rigorous adherence to the current guidelines that suggest they aren't first-line therapy. There are other things to be used first, and, for many patients, that may be all they need," he said.

Meanwhile, research findings suggest that some groups -- such as African-Americans -- might be at especially higher risk if they use the drugs, he said.

It's unclear how the drugs work, and it's not known why they can be dangerous for some people and not others, Glassroth added, although genetic factors may play a role.

Little B Goes to the Peds Neurologist

Just another quickie: We took #1 son per his Child Study Team, who suspected he might be on the autistic spectrum because of his arm-flapping and toe-walking.

The brief summary: The neurologist thinks they're all nuts. Apparently these things are "soft markers" for autism, he's completely fine, and the regimen of Physical and Occupational therapy he's currently getting through the school system is sufficient.

I think she was just glad we weren't looking for a prescription for Concerta or Ritalin! I think the docs around here are pretty sick of prescribing that stuff...

Anyway, we're still going to have to take him to another Neurologist, as the school system will be sending him to theirs, but needless to say...we're relieved and pretty optimistic!!

Pediatric Asthma is Just Weird Sometimes

Quick Update: Oz began a flare on Saturday -- just cranky and a little "off." He started coughing Sunday, and was coughing a lot on Monday. Monday night was a misery -- he woke up screaming because he couldn't stop coughing. Thank God we'd just gotten a lifetime supply of Xopenex from the mail-order Rx, and I'd already started DuoNeb.

I called and checked on him in daycare yesterday repeatedly, even though he'd been okay during the day -- just rough from late afternoon through early AM. But I was ready to pick him up if need be, and I'd left instructions to give him albuterol twice during the day.

I called the peds. pulmonologist yesterday just to give them a "heads up" and make sure I was taking action appropriately. I was sure I'd have to rush him over there this morning.

But, in typical asthma flare fashion, he was completely fine by the time I picked him up yesterday. Not a single cough the entire evening.

How weird is that? Monday night, he's coughing his head off. Tuesday night, nothing.

I'll taper off the rescue meds gradually, just to be safe!

Scary Headline in Fox News: Survey: 1 in 3 Fatal Asthma Attacks Involves a Child With Mild Form

Here's a terrifying news story to share with all you moms who are just getting comfortable with your kids' asthma. As if worrying about terrorists bombing your local shopping mall wasn't enough to give you nightmares. Or the fact that some inhalers might be "deadly." (Whoops. Forgot to post that. Coming up.) Anyway, the story is reprinted in full below:

Survey: 1 in 3 Fatal Asthma Attacks Involves a Child With Mild Form

VIENNA, Austria — One in three fatal asthma attacks worldwide involves a child with a mild form of the disease, and nearly half of all parents are unaware of the death risk, according to a new global survey presented Wednesday.

The European Academy of Allergology and Clinical Immunology said the findings exposed a critical information gap between doctors who treat asthma and the parents of youngsters diagnosed with it.

"Many patients with asthma underestimate their disease severity and overestimate their degree of asthma control," the academy warned in the report issued at its annual conference, held this year in Vienna.

Dr. G. Walter Canonica, of the University of Genoa in Italy, said the survey underscored how effective treatment "is a shared responsibility requiring continuous communication among physicians and children with asthma and their parents."

"One place to start is in the area of treatment side effects ... in many cases, parents are not able to identify these side effects," he said.

Experts said that with each decade, the prevalence of asthma increased 50 percent. Worldwide, more than 300 million people are afflicted and more than 180,000 die of the disease each year, the Global Initiative for Asthma says.

Asthma is a chronic lung disease caused by airway inflammation, and certain stimuli cause the windpipe to become obstructed. Symptoms include wheezing, coughing and a tightened airway that causes shortness of breath and can be life-threatening. Allergies are responsible for more than 50 percent of asthma in adults.

Treatment for the condition costs society more than tuberculosis and HIV/AIDS combined, the European Academy said.

Its survey of 5,482 asthma patients, their doctors and the parents of young sufferers focused on cases in Britain, Canada, France, Germany, Italy, Japan, Spain, Switzerland and the United States. The academy called it the first sweeping global study of what parents do and don't know about the hazards of asthma.

Many parents cut back on treatments such as the use of drug inhalers when their children suffer side effects, the study found. Others switch asthma medications or discontinue treatment altogether, it said, cautioning that doing so "can be dangerous and greatly impact health outcomes."

Reducing or stopping treatment usually means a child's condition worsens, the report warned.
"More than three-fourths of children who are not compliant with their asthma treatment all the time experience at least one of the following: increased symptoms (66 percent), limited physical activity (48 percent), nighttime awakenings (46 percent) and more frequent asthma attacks or exacerbations (40 percent)," it said.

Those who don't follow doctors' orders end up with 38 percent more visits to physicians and are 14 percent more likely to wind up in an emergency room or hospitalized, the survey said.
Experts said that although 59 percent of parents say they comply with their doctors' instructions all the time, only 9 percent of physicians believe it because the child's symptoms are not controlled. And parents and doctors both complain that the other side doesn't initiate discussions about treatment and side effects.

"Patients with asthma, parents, and the physicians who treat them should pay close attention to the findings from this survey, which show that the way we currently treat asthma is unsatisfactory," said Dr. Erkka Valovirta, a pediatrics specialist at Finland's Turku Allergy Center.

Thursday, June 01, 2006

New Resource: RemedyFind

Just a quick one: Not sure how good this is, but it was posted to the Asthma-Parents email list --


Let me know what you think. I'm hoping it's not another scam site selling liquid oxygen or something ridiculous like that. It would be cool to have another useful, unbiased asthma site in the universe!