First off, the risks are much more pronounced in African Americans. If I, or my family members, were African American, I would be more concerned about serevent. Second, the issue with serevent is not actually with just the drug serevent (salmetrol for all you canadians<img src="i/expressions/face-icon-small-smile.gif" border="0">) but with the class of drugs - namely Long Acting Bronchodilators (LABA). Studies have shown a slightly increased risk of severe asthma attacks, and even death (still a small risk but statistically significant risk.) Not enough studies have been done to determine WHY there is an increased risk.
Here's my thoughts. Please bear in mind that it is just speculation on my part, but speculation based on lots of research on this issue (since all three of my children are currently on advair, two since age 5.) Ok, the thing is long acting bronchodilators are meant to DECREASE the use of short acting bronchodilators like albuterol. They both work the same way - short acting just start sooner and wear off sooner, long acting start working later and wear off later. THEREFORE, if you start using a long-acting bronchodilator like serevent or foradil, you SHOULD be using your albuterol LESS. If you're not, there's a problem. I think doctors don't explain this clearly enough. If a patient, before advair, used albuterol every 2 hours during a bad flare up, once they start using serevent or foradil, if they have a flare up that requires albuterol every 2 hours, it is a WORSE flare up than before advair because the patient has already taken long acting bronchodilators and should be using LESS albuterol. From my experience (with a total of 4 different drs prescribing advair), most drs do NOT explain this clearly to their patients. I think the problem with the more frequent deaths is at least partly attributed to the fact that patients do not realize that they cannot gauge the severity of their asthma flare ups ON long acting bronchodilators by the same guidelines they gauged them BEFORE long acting bronchodilators. For example, with my almost 8 year old, before advair, if he had a severe asthma flare we were allowed to give 3 treatments of xopenex back to back (wait 15 minutes between each tx.) At that point, we called for instruction. Now, since he's on advair, we can give 2 treatments of xopenex back to back before calling for help because he will have had THREE doses of bronchodilators - 2 short acting, 1 long acting.
Last thing, if you don't have an asthmatic component to your cf, and are on advair just for the cf, these warnings may not even apply to you. My understanding is that they don't apply to the COPD (chronic obstructive pulmonary disease) folks like they do asthmatics. I'd talk to your pulmonologist and get his opinion before making any decisions.
Medscape has a few different articles on this subject: www.medscape.com
Here's my thoughts. Please bear in mind that it is just speculation on my part, but speculation based on lots of research on this issue (since all three of my children are currently on advair, two since age 5.) Ok, the thing is long acting bronchodilators are meant to DECREASE the use of short acting bronchodilators like albuterol. They both work the same way - short acting just start sooner and wear off sooner, long acting start working later and wear off later. THEREFORE, if you start using a long-acting bronchodilator like serevent or foradil, you SHOULD be using your albuterol LESS. If you're not, there's a problem. I think doctors don't explain this clearly enough. If a patient, before advair, used albuterol every 2 hours during a bad flare up, once they start using serevent or foradil, if they have a flare up that requires albuterol every 2 hours, it is a WORSE flare up than before advair because the patient has already taken long acting bronchodilators and should be using LESS albuterol. From my experience (with a total of 4 different drs prescribing advair), most drs do NOT explain this clearly to their patients. I think the problem with the more frequent deaths is at least partly attributed to the fact that patients do not realize that they cannot gauge the severity of their asthma flare ups ON long acting bronchodilators by the same guidelines they gauged them BEFORE long acting bronchodilators. For example, with my almost 8 year old, before advair, if he had a severe asthma flare we were allowed to give 3 treatments of xopenex back to back (wait 15 minutes between each tx.) At that point, we called for instruction. Now, since he's on advair, we can give 2 treatments of xopenex back to back before calling for help because he will have had THREE doses of bronchodilators - 2 short acting, 1 long acting.
Last thing, if you don't have an asthmatic component to your cf, and are on advair just for the cf, these warnings may not even apply to you. My understanding is that they don't apply to the COPD (chronic obstructive pulmonary disease) folks like they do asthmatics. I'd talk to your pulmonologist and get his opinion before making any decisions.
Medscape has a few different articles on this subject: www.medscape.com