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Thursday, June 05, 2008

New Asthma guidelines (again) and another meta-analysis re:LABAs and asthma

The National Heart,Lung and Blood folks have authored still another set of asthma guidelines-all you would ever want to know in 440 pages. (5.22 MB).Several links from the NHLBI site did not work and one version was only 3.88 MB. This one seemed to work, however.Physicians who treat asthma are obligated to plow through it but if you prefer to read the written page as opposed to the computer screen be prepared to replace your print cartridge.

In other asthma news,the issue of the safety of LABA use in asthma has been revisited in a recent issue of the Annals of Internal Medicine.I have written before about the candidate for the worse randomized clinical trial of the century,the memorably flawed SMART trial, and the subsequent impressively flawed meta-analysis (relying heavily on the results of SMART) unfortunately published in the Annals of Internal Medicine by the Salpeter team and the kurfuffle it generated. In an act of apparent contrition, the Annals has published another meta-analysis regarding the use of long acting beta agonists (LABAs) in the treatment of asthma and found LABAs innocent. (Since I have been so critical of certain aspects of meta-analyses,one could ask why I would believe this paticular one. The answer is I believe-or at least I quote- those that conform with my preconceived notions and biases about the subject.) Here is another meta-analysis that provides support for the widely held position and my notion that LABAs are beneficial in COPD.

Used properly LABAs add value to asthma treatment. They are to be added to the treatment program after inhaled corticosteroid (ICS) have been started but along with resuce beta agonist use appear to be inadequate for control. This is the role for LABAs according to the new guidelines. LABAs are not to be used for rescue therapy. Frequent use of a short or long acting beta-agonist in a poorly controlled asthmatic (one who should be on steroids) is a harbinger of ER visits, a required intubation and worse.


Friendly Curmudgeon said...

Glad you are a retired doc not taking care of asthmatics, those guidelines have been out for a year (that is if you believe following guidelines from NIH is good patient care!)

Retired from practice also, but do work for client that sells several key asthma meds, ;-)

james gaulte said...

Yes, they were published in October 2007.I probably should have said latest rather than new.