In children with persistent Asthma, twice daily treatment with Advair - a combination of the corticosteroid fluticasone and the bronchodilator salmeterol - is well tolerated and has a safety profile similar to fluticasone alone, investigators report.
Dr. Randolph Malone from Southeast Asthma and Allergy Center in Tallahassee, Florida and colleagues say the use of salmeterol with an inhaled corticosteroid “represents a treatment option” for patients who continue to experience Asthma symptoms while taking an inhaled corticosteroid.
This approach “minimizes the risk of systemic effects that can occur when either higher doses of inhaled corticosteroids or oral corticosteroids are administered,” they write in the Annals of Allergy, Asthma and Immunology.
Last month, an advisory panel to the U.S. Food and Drug Administration unanimously ruled that three bronchodilator asthma drugs - salmeterol (Serevent), formoterol (Foradil), and fluticasone-salmeterol (Advair) - are safe enough to stay on the market amid concerns they raise the risk of severe asthma attacks in rare cases.
Asthma is an inflammatory disorder of the airways, characterized by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing.
In their study, Malone’s group assigned 203 children 4 to 11 years of age, who experienced persistent asthma during inhaled corticosteroid therapy, to take Advair or fluticasone alone twice daily for 12 weeks.
The children tolerated both treatments well. The most common adverse events included headache, upper respiratory tract infection, throat irritation, gastrointestinal discomfort and pain, nausea and vomiting, and fever. No serious drug-related adverse events were reported in either group.
Two children on Advair and five taking fluticasone withdrew from the study due to worsening asthma.
These results, the authors conclude, demonstrate that twice-daily treatment with fluticasone and salmeterol is as safe as fluticasone alone in children.
Causes, incidence, and risk factors
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. When an asthma attack occurs, the muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. Mucus production is increased.
Most people with asthma have periodic wheezing attacks separated by symptom-free periods. Some asthmatics have chronic shortness of breath with episodes of increased shortness of breath. Other asthmatics may have cough as their predominant symptom. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted.
In sensitive individuals, asthma symptoms can be triggered by inhaled allergens (allergy triggers), such as pet dander, dust mites, cockroach allergens, molds, or pollens. Asthma symptoms can also be triggered by respiratory infections, exercise, cold air, tobacco smoke and other pollutants, stress, food, or drug allergies. Aspirin and other non-steroidal anti-inflammatory medications (NSAIDS) provoke asthma in some patients.
Asthma is found in 3-5% of adults and 7-10% of children. Half of the people with asthma develop it before age 10, and most develop it before age 30. Asthma symptoms can decrease over time, especially in children.
Many people with asthma have an individual and/or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies or evidence of allergic problems.
SOURCE: Annals of Allergy, Asthma and Immunology, July 2005.
Revision date: June 18, 2011
Last revised: by Andrew G. Epstein, M.D.