December 15, 2008
I don't have asthma, and I am fortunate to never have had to struggle with the sudden feeling of breathlessness and helplessness that asthma can cause. But I do have children, and though none of them have asthma, I can't imagine anything more frightening than seeing one of my children struggling to breathe.
This is why I am so upset to learn that two FDA safety officials recently wrote on the FDA website that no one should use the effective and hugely popular asthma drugs, Advair, Symbicort, Serevent and Foradil. While it is true that there have been rare deaths associated with these drugs, it has not been shown that these medicines caused the deaths. Further, how many deaths have been caused by severe asthma attacks in patients who didn't have access to these powerful inhalers as preventatives?
It is this crucial question that an FDA safety official should consider before posting such an advisory. But in the meantime, though the FDA has a responsibility to warn, it also has a responsibility to not slam lifesaving treatment without evidence. The FDA also has a responsibility not to be too impulsive or fear-provoking.
Don't get me wrong, the FDA is wise to be somewhat cautious about these drugs, and I think a trained pulmonologist with a proven expertise in asthma should be the one prescribing them. My office mate, Dr. Francis Adams, author of The Asthma Sourcebook, is just such an asthma expert, and he would be the first to say that these inhalers represent necessary arrows in the lung doctor's quiver.
Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear