( s' letter follows up a related editoria...)Salmeterol - to be used in combination & only when required,Health

s' letter follows up a related editorial published December 2005 in the NEJM by Fernando Martinez, M.D., a leading asthma expert. The letter also helps illustrate findings reported this year in a large, population-based study in the United States that is consistent with a previous study in England.

The U.S. study showed a very small, but statistically significant, increased risk of asthma-related deaths -- 13 among 13,000 individuals who received salmeterol but only three among another 13,000 individuals who received a placebo during a 28-week treatment period. Other studies have suggested that some people have a genetic variation that causes them to respond negatively to the class of medications that includes salmeterol, Weinberger said.

The concern about salmeterol and a related medication, formoterol, led the U.S. Food and Drug Administration this year to add a "black box" warning to products containing these medications.

The warning is appropriate, Weinberger said, but many people, including health care professionals, remain unaware of the problem. To raise awareness, Weinberger and Mutasim Abu-Hasan, M.D., UI clinical associate professor of pediatrics, documented two cases they saw at the UI that showed the risk of these medications.

Each of the two patients had life-threatening problems related to salmeterol use. When the patients switched to a different asthma medication, their asthma was successfully managed.

Weinberger emphasized that people currently taking asthma medication that contains salmeterol should continue taking it until they consult their physicians.

"For many patients, adding salmeterol to an inhaled corticosteroid provides additional clinical benefit. Patients should contact their physicians if they notice their response to a 'rescue' inhaler such as albuterol is lessened when they're taking salmeterol as part of a regular maintenance medication," he said.

Weinberger said th
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