How Would You Like an LABA Substitute?

I came across an article on the Denver Post website this morning you should read. In it, you’ll learn about tiotropium, a COPD medication that could serve as an alternative treatment for people who need long-acting beta-agonists like Serevent.

LABAs, you’ll recall, work just fine for most asthmatics but now carry a black-box warning because of their connection to severe and fatal asthma attacks for a small percentage of patients. No one really knows why some people can’t tolerate LABAs while most can, so another option would be a good thing.

This particular article, though, contains some puzzling terminology that a casual reader likely wouldn’t even notice but could easily confuse people new to asthma. Namely, I didn’t find the descriptor “long-acting” one time – not once – in the entire story, save for a quote 2/3 of the way down from National Jewish’s Richard Martin, lead investigator of the Denver-area portion of the study.

Plus, the story doesn’t even name the specific LABAs in question until the seventh paragraph:

Beta agonists, such as Serevent and Foradil, are commonly used in combination with inhaled corticosteroids. Medicines such as Advair and Symbicort contain the combination.

Is it just me, or is that sentence really unclear? Not only does it imply meds like Serevent and Foradil are the only type of beta-agonists available, but the entire article also makes no mention of any other kind.

Just look at the lead:

Asthma sufferers worried by research that beta-agonist drugs used to control their condition might pose a risk of death could have an alternative, according to a study published Sunday in the New England Journal of Medicine. [emphasis mine]

If I’d read that sentence when I first started learning about my daughter’s asthma, my brain would have defaulted to, IS THE BREATHING PROBLEM NOT ENOUGH? YOU’RE TELLING ME THE MEDS TO TREAT IT ARE RISKY, TOO?

Remember, people:

Asthma treatment options include two types of beta-agonists. Only the long-acting ones are at issue here. The short-acting beta-agonist salbutamol/albuterol, like in the very common ProAir HFA, is the everyday quick-relief inhaler most people use and doesn’t have a black-box warning. There’s a big difference.

60 responses to “How Would You Like an LABA Substitute?”

  1. Samantha says:

    While having something without a black box wuould be nice I admit, my girl takes Advair (second step in the 3 steps). While im worried about the risks.. im MORE worried about her not breathing properly.
    Singulair got black boxed too, but drop that one since it didnt seem to be helping my kiddo (according to me, her pediatricin, and her pulmonogist

  2. Many moons ago when these bad things were first reported I remember asking my Pulmo about it. His answer at the time was that the study was done amongst a certain group of the population who had not received proper/adequate asthma treatment/education and did not know that a LABA was not a reliever in an attack. I was first prescribe Serevent (Salmeterol) in 1994 and received so much info about how it was a twice a day drug and would do nothing for me in an acute attack or even for a little wheezy coughing flare up. I can even remember myself (stupidly) taking extra doses of it when poorly-just in case-but of course feeling nothing other than a racing heart!
    I also remember being in a country hospital and having it taken away from me as nobody knew what it was for.

    Likewise when I was started on Spiriva (the COPD drug that has been in the press this week), the admitting Pulmo doc took that away and said I was an asthmatic and didn’t need a COPD drug.

    Subsequently I was started on Ipratropium!

    There is a lot of knowledge lacking amongst many Doctors. The big guns in the top hospitals know their stuff, sure, but if you ever have the misfortune of ending up in a small country type ER-like I have and did on both these occasions, then make sure your Asthma Action Plan states WHY you are taking such medications-it’s often the only way to over rule their judgments.

    The moral-the black boxing of LABAs is, in my opinion, more greatly because the Docs and the Patients don’t understand their function in the more vigorous treatments of types of asthmas. Hence the inevitable fatalities, I am sorry to say.

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