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Case Reports Highlight Salmeterol's Dangers
Two case reports illustrate the need to monitor carefully patients with severe asthma who are on salmeterol, according to the authors.
The reports, which appear in today's New England Journal of Medicine, briefly describe two adolescent boys receiving corticosteroids and salmeterol. Their response to rescue inhalers was inadequate and they derived no protective effect from shorter-acting beta-2 agonists taken before exercise. Both had profound bronchospasm leading to asphyxial episodes after brief exertion and required repeated inhalations of albuterol to achieve recovery.
When their salmeterol was replaced with theophylline, however, both patients had improved control and tolerated exercise after pretreatment.
The authors say that the cases, though uncommon in their severity, support the need for close medical monitoring of patients whose asthma requires the addition of a long-acting beta-2 agonist.
Salmeterol and other long-acting beta-2 agonists were the subject of an FDA advisory last November warning that the drugs could worsen asthma episodes or even cause death.
Link: NEJM case reports (Subscription required)
Link: Original FDA advisory (Free)
Published in Physician's First Watch August 24, 2006