Asthma experts at University of Iowa are taking efforts to make sure that an asthma drug combination is prescribed only when really needed.//

Salmeterol is a long-acting asthma drug that is used in combination with a corticosteroid, which is inhaled. The use of this combination can deteriorate the asthma for a few people with that condition.

The UI physicians reported two cases representing the few patients for whom the combination can make asthma more severe or even fatal in a letter published in the Aug. 24 issue of the New England Journal of Medicine (NEJM).

"For most patients whose asthma cannot be controlled with a low-dose inhaled steroid, adding salmeterol to the steroid provides increased benefits. So there's no question this can be a useful combination drug for many individuals," said Miles Weinberger, M.D., professor of pediatrics in the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

"However, some patients are receiving the combination drug but don't actually need it, and there is at least a small subgroup of patients for whom previous research showed the salmeterol-steroid combination has a very negative, rather than beneficial, effect," said Weinberger, who also directs the UI Division of Pediatric Allergy and Pulmonary Diseases.

Advair, made by GlaxoSmithKine, contains salmeterol in addition to an inhaled corticosteroid and is extensively marketed, Weinberger said. It is one of the most commonly prescribed maintenance asthma medications in the United States and is meant to be used by patients on a regular, preventive basis, not to treat sudden asthma attacks.

"We do not want to unduly alarm people, but instead help spread the word that patients should talk with their physicians if they are using Advair, or another inhaled asthma medication that contains salmeterol and feel that it worsens symptoms instead of making them better," Weinberger said.

The UI physician
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