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Monday, December 3, 2012

Revisiting LABAs with the help of Macbeth


Szefler and Busse provide an entertaining and thoughtful editorial this month on the predicament of LABA step-down by invoking Macbeth’s notorious witches’ ominous chant (J Allergy Clin Immunol 2012;130:1256-1259). Likening the clinician’s dilemma at the FDA recommendation to withdraw LABAs for safety reasons from treatment of well-controlled asthma to the troubling brew of the witches, the authors review the history of long-acting beta 2 agonists’ use and the evidence that supports the safety concerns that prompted the FDA’s action. Szefler and Busse note that a recent evidence review does not concur that LABAs are unsafe when used in combination with ICS and, in fact, concludes that withdrawal of LABAs in that treatment context results in asthma worsening.

At the heart of the controversy are several “Catch-22s”: how and when to step down and, critically, with what to replace LABAs if control is lost. Clinicians and researchers are concerned that the delay in safety reporting will also delay the development of new asthma drugs in the LABA category. Further, the FDA safety trial does not address how to step-down LABAs in the event of a poor safety profile. This would require yet another set of trials, which implies further delays.

Results from the current FDA-mandated safety study are expected to be reported in 2016. Until then, the authors provide approaches for possible step-down in patients on ICS and LABA combination products. Among these, they suggest that clinicians consider the asthma natural history, especially over the previous year, the possibility of adjusting either the ICS or the LABA, and alternative supportive treatments, such as omalizumab or tiotropium, if they decide to step-down the LABA. Szefler and Busse emphasize that there is no current evidence that supports changing the current EPR-3 guidelines, which already advise against LABA monotherapy.

23 comments:

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  6. i am very grateful sharing this great testimonies with you,how Dr.Okaya win lottery number,and is The best thing that has ever happened in my life is how i won the lottery. and tell him i need the lottery numbers. i have come a long way spending money on ticket just to make sure i win. But i never know that winning was so easy until the day i meant the spell caster called Dr.Okaya online which so many people has talked about that he is very great in casting lottery spell, so i decide to give it a try.I contacted this Dr.Okaya and he did a spell and he gave me the winning lottery numbers. But believe me when the draws were out i was among winners. i win ( thirty Five million,thirty five thousand,three hundred and twenty three Dollars). Dr Okaya truly you are the best, with these man you can will millions of money through lottery. i am so very happy to meet these man, i will forever be grateful to you. Email him OKAYASPELLHELP@GMAIL.COM for your own winning lottery numbers, is the only way out and answer to that your problem call/Whats app +27814506790 for More Information on Dr Okaya

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    Here is our price list for ATM cards:
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    $2,500--------------$200
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    $10,000 ------------- $800
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    ReplyDelete
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  9. Its a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) for good four (4) years, six (6) months and twelve (12) day with my calculations, before I meet the great Dr. Sambo. I am DEBORAH BALOGH from Fresno California, united state of America and I was affected with herpes virus. Herpes is a viral infection cause by the Herpes simplex virus, marked by painful, watery blister in the skin or mucous membrane or on the genitals. This was what I suffered for good four years. I have visited CVS Pharmacy in Fresno for treatment but no improvement. I meet Dr. Sambo online while I was searching for herpes cure I read a testimony about his work. I give a try that now becomes a testimony in my life. I contacted Dr. Sambo via his E-mail divinespellhome@gmail.com and he did not responds to me in time and I went back to the same testimony for his mobile number and I called him immediately +1(267)527-9481 and he respond to my call. He welcome me as a daughter and I explain my four years situation to him and he said is done just as I have contacted him and I believed in him. Dr. Sambo sends me some herbal medication for herpes cure and he gave me instruction on what to do and I obeyed his instruction. Changes started after three days of applying the herbal medication. I went to the same CVS Pharmacy in Fresno for test and i was herpes negative. I do not know how to thanks Dr. Sambo for saving my life. To God be the Glory, I am living healthy with my family today.Indeed, Dr. Sambo is a great man divinespellhome@gmail.com Dr. SamboWhatsApp him now +1(267)527-9481 God bless Dr. Sambo for his good work...

    ReplyDelete
  10. Its a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) for good four (4) years, six (6) months and twelve (12) day with my calculations, before I meet the great Dr. Sambo. I am DEBORAH BALOGH from Fresno California, united state of America and I was affected with herpes virus. Herpes is a viral infection cause by the Herpes simplex virus, marked by painful, watery blister in the skin or mucous membrane or on the genitals. This was what I suffered for good four years. I have visited CVS Pharmacy in Fresno for treatment but no improvement. I meet Dr. Sambo online while I was searching for herpes cure I read a testimony about his work. I give a try that now becomes a testimony in my life. I contacted Dr. Sambo via his E-mail divinespellhome@gmail.com and he did not responds to me in time and I went back to the same testimony for his mobile number and I called him immediately +1(267)527-9481 and he respond to my call. He welcome me as a daughter and I explain my four years situation to him and he said is done just as I have contacted him and I believed in him. Dr. Sambo sends me some herbal medication for herpes cure and he gave me instruction on what to do and I obeyed his instruction. Changes started after three days of applying the herbal medication. I went to the same CVS Pharmacy in Fresno for test and i was herpes negative. I do not know how to thanks Dr. Sambo for saving my life. To God be the Glory, I am living healthy with my family today.Indeed, Dr. Sambo is a great man divinespellhome@gmail.com Dr. SamboWhatsApp him now +1(267)527-9481 God bless Dr. Sambo for his good work...

    ReplyDelete
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  13. Save Your Relationship and Get Your Ex Boyfriend/Girlfriend Back! contact: MiracleSpellHome@yahoo.com is certainly the best spell caster online and his result is 100% guarantee

    It's a privilege to share this miraculous testimonies to the world. I'm Cory Crow from Australia. My husband divorced me 4 months back and i have been filled with remorse for i didn't know what to do to amend issues with my husband. I searched for help on the internet on how i could get help in my marriage and i discovered great testifiers about Dr miracle who has been progressive with his spells. I got in touch with him and behold, Dr Miracle told me that he will prepare a spell for me that will bring back my husband. I was skeptical but i had no other option but to work with him. 2 days after, my husband called me that he's coming back home and from that day till this moment, we have been living peacefully. He is back now with so much love and caring. today i am glad to let you all know that this spell caster have the powers of bring lovers back. because i am now happy with my husband,and the most surprise,is that our love is very strong,every day is happiness and joy. and there is nothing like been with the man you love. I will highly recommend Dr Miracle to anyone one out there who needs help whatsoever.if you have any problem contact Dr Miracle, i give you 100% guarantee that he will help you!!.

    (MiracleSpellHome@yahoo.com)
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  14. I want to appreciate Dr Oshuku for what he did for me and my family, I was diagnose with herpes for two years till i came across him on the internet then i contact him, he give some instructions i follow and he prepare me a herbal medicine which i use for three weeks after then i went for a test to my greatest surprise the result was negative. I don't want share because i know there are people at there who are suffering with this virus contact him and be save droshuku@gmail.com or WhatsApp +2348130419838

    ReplyDelete
  15. I want to appreciate Dr Oshuku for what he did for me and my family, I was diagnose with herpes for two years till i came across him on the internet then i contact him, he give some instructions i follow and he prepare me a herbal medicine which i use for three weeks after then i went for a test to my greatest surprise the result was negative. I don't want share because i know there are people at there who are suffering with this virus contact him and be save droshuku@gmail.com or WhatsApp +2348130419838

    ReplyDelete
  16. I have always wanted the best for me and my lover We live together so happily that we had never have issues which we can't resolve. He was the best for me. We have been married for over 2  years now. I was lost in confusion when he told me he don't want our marriage anymore, this happened when he came back from his trip with all the saying that he has found another woman he love so much and want a divorce. I pleaded with him and he should please consider our kids too. My words where so useless to him. I was so confused that I have to seek for help and solution when I came across this prophetess. he told me what I need to do so I did and after 48 hours my lover  came back apologizing for everything he has done and want us back again. Now I happy to share this with everyone for what @Drbowsolutionhome has done for me. You can also seek help from him by contacting him on WhatsApp+2348121786772 or email address drbowsolutionhome@gmail.com

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