Asthma Recommendations

Currently, two long-acting beta2-adrenergic agonists (LABAs) have FDA marketing approval for the treatment of asthma – salmeterol (the active ingredient in Serevent Diskus and Advair) and formoterol (the active agent in Foradil and Symbicort). Each of these agents works by relaxing smooth muscle in the respiratory tract, allow- ing you to breathe easier by decreasing shortness of breath and wheezing.

The FDA is warning healthcare providers that the use of LABAs is contraindicated without the use of an “asthma controller medication” such as an inhaled corticosteroid. To ensure compliance, the agency is suggesting a combination product such as Advair Diskus, Advair HFA, or Symbicort be used, particularly in pediatric and adolescent patients. These products contain both an LABA and an inhaled corticosteroid such as fluticasone or budesonide. The FDA also recommends that LABAs be used for the shortest period required to achieve control of asthma symptoms and then be discontinued, if possible. LABAs should be used long-term only by patients whose asthma cannot be adequately controlled with controller medications.

Physicians agree that it is best to combine an LABA and an ICS, rather than using an LABA alone, and they said that these medications offer an important treatment a option. “As a practicing physician, my experience is that combination medications [containing a 12-hour bronchodilator along with an inhaled corticosteroid in one dose] have changed how effective I’ve been able to be as a physician,” said William Busse, MD, chairman of the NIH Expert Panel 3. “We don’t see asthma patients being admitted into the hospital like before.”

But this is where agreement with FDA’s recommen- dation ends. Stanley Szefler, MD, also a member of Expert Panel 3, emphasized the importance of continu- ing to use a 12-hour bronchodilator if it’s helping a patient manage symptoms. “It doesn’t make sense to bring a patient to [a level of] good control and then stop what got them there,” he said. “It’s a lot like achieving good blood pressure, then stopping the medication. We are con- cerned that patients will achieve control and then stop the medication,” which he said could lead to dangerous consequences.Physicians agree that it is best to combine an LABA and an ICS, rather than using an LABA alone, and they said that these medications offer an important treatment a option. “As a practicing physician, my experience is that combination medications [containing a 12-hour bronchodilator along with an inhaled corticosteroid in one dose] have changed how effective I’ve been able to be as a physician,” said William Busse, MD, chairman of the NIH Expert Panel 3. “We don’t see asthma patients being admitted into the hospital like before.”

Stay Motivated with the Wii

If you have graduated from a pulmonary rehabilita- tion program, it is often hard to stay motivated to maintain the gains you have achieved. Data suggests a return to pre-program levels of quality of life and exercise capacity within 6 to 12 months. Many people often fail after rehabilitation because regular exercise at home and healthy lifestyle options are not maintained. The Wii video game system can maintain the positive effects of pulmonary rehabilitation. Playing a Wii game could provide both mental stimulation and physical exercise in the comfort of one’s own home. It may be the extra factor needed keep you motivated in the long term. Exercising with the Wii can get the whole family involved in the process and make exercise more fun and

less of a chore. The use of Wii in the rehabili- tation of patients following a stroke and in children with cere- bral palsy is gaining momentum.