tag:blogger.com,1999:blog-12660458.post115072291765325514..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: A "simple" questionUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-12660458.post-1150912935013706842006-06-21T14:02:00.000-04:002006-06-21T14:02:00.000-04:00I agree. This meta-analysis seems a to be like st...I agree. This meta-analysis seems a to be like statistical alchemy. If we combine several studies that failed to show any statistically significant differences, then we magically produce a statistically significant result. <BR/><BR/>Even if there is a "statistically significant" increased risk, I agree that it is, indeed, very small. <BR/><BR/>Of course, lawyers don't see it this way. Just google "Advair" and see what pops up in the top 10 links...Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1150752004617748282006-06-19T17:20:00.000-04:002006-06-19T17:20:00.000-04:00I think carlos' point is the KEY to this argument....I think carlos' point is the KEY to this argument. These studies that are listed are mostly ones performed with drugs in the ABSENCE of inhaled corticosteroids.<BR/>In the studies that include corticosteroids there is no data showing an increased risk of exacerbation or death from LABA.<BR/>Also, as CEOB mentions, these studies are performed in asthmatics.<BR/>My practice is to begin LABA in asthmatic individuals only when they are not controlled with inhaled CS. COPD is a different disease, and I rarely use LABA without ICS in those patients as well.<BR/>As an aside, GSK people should use this as a marketing ploy so that people do not use LABA's without a steroid/Mike Lhttps://www.blogger.com/profile/12177750268091750583noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1150733899454932622006-06-19T12:18:00.000-04:002006-06-19T12:18:00.000-04:00Jeff, I think that is a great question. I have ha...Jeff, I think that is a great question. I have had several patients asking me about Advair, I have seen the issue discussed on TV and on NPR...<BR/>To me there are several problems to how this was handled.<BR/>One is that, indeed LABA alone should not be the preferential maintenance therapy for asthma. The problem with increased mortality happened mostly in inner city kids with poor access to health care who felt better but had worsening inflammation and when they got help it was too late. That should not translate into LABAs, even coupled with an ICS are always bad.<BR/>I also get a lot of questions from old smokers with no asthma who might be on Spiriva and Foradil to try and improve their dyspnea and I don't think the problems with asthma and LABAs apply to them: different diseases, different inflammatory cells, an most of my COPD patients are not inner city youths.Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1150728062145646432006-06-19T10:41:00.000-04:002006-06-19T10:41:00.000-04:00I agree with editorial in the same issue of Chest ...I agree with editorial in the same issue of Chest that published the SMART trial results.(O'Byrne and Adelroth)-Chest:2006;129:3-5-Admitedly it was published before the Salpeter paper, but they did not recommend stopping salmeterol.<BR/>The SMART trial was one of worst trials ever in many regards and I hope it will not cause widespread d/c ing salbuterol containing drugs.I talked about some of SMART's problems in recent blog. (Retired doc's Thoughts).I am still pondering the Salpeter article.james gaultehttps://www.blogger.com/profile/05537303135780186926noreply@blogger.com