From D M HUMPHREYS
William Bown is to be complimented on the breadth of his most recent
review of asthma and its treatment (‘Are asthma drugs a cure that kills’,
6 April). There are, however, one or two further points that should be made.
He states that ‘fenoterol excites the heart more than other beta-2-agonists’.
This has only been shown convincingly at doses which significantly exceed
the recommended dose of fenoterol and in healthy subjects or patients with
mild asthma. Further, the New Zealand data lead one to a variety of possible
conclusions, not least that patients with more severe asthma were at the
time being selectively prescribed fenoterol and thus that the association
with asthma mortality was not causal.
The data from the study by Sears et al did not conclude that fenoterol
made the asthmatics worse. The authors concluded that regular as opposed
to intermittent use of the beta-agonist made a proportion of asthmatics
worse.
Finally, I am unaware of any data in the asthma treatment literature
which confirms in any way the statement attributed to Glaxo that salbutamol
is ‘intrinsically safer’ than fenoterol.
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What is more important is that chest physicians, drug regulators and
pharmaceutical company drug development professionals consider in a collaborative
manner how to optimise the clinical management of asthma with particular
emphasis on how best to use beta-agonists given their valuable and, at times,
life-saving properties.
D M Humphreys Medical Director Boehinger Ingelheim Ltd Berkshire
