DR. HOOK- Asthma meds: Studies help no one breathe easier

"Okay, name this tune in four notes: "Da Da Daaaaaaaaaa-DUH!" (I need to ask my editor to work on making The Hook like one of those Hallmark cards that plays music when you open it.) A book of trivia in our waiting room has a ton of great info on the 1960s TV comedy Get Smart.

As a child in the '70s, I watched every re-run of Max Smart and 99 in their attempts to defeat the evil organization of KAOS. We never knew 99's real name, and according to the book, her original agent name was supposed to be 69 (myth or truth?). Once 99 said her real name was Susan Hilton– but it was revealed later that that claim was a lie. How do we know what's true and what's false?

A SMART study has been recently published. It's not Max Smart, but a Salmeterol Multicenter Asthma Research Trial. It must take researchers weeks to design study names. I would come up with a study like GO GIRL: Get On Good Information Relatively Late. (I told you it was hard to come up with a good name.)

Asthma affects up to 42 percent of American adults in one way or another according to some reports, though the exact prevalence is unclear. Asthma involves inflammation of the airways that makes it difficult to breathe, in particular to breathe out– kind of like a bagpipe. The prevalence of asthma has been increasing throughout the world. ER visits and deaths have also been increasing over the last couple of decades– in particular for African Americans.

Why? We don't know for sure.

Asthma is treated with short-acting beta agonists like albuterol. In the movie The Hand That Rocks the Cradle, our asthmatic heroine was doomed by Rebecca De Mornay's tampering with the albuterol inhaler. Tonya Harding, Ms. Hit-Kerrigan-In-The-Knee Figure Skater, would puff her albuterol like cigarettes (or sometimes with cigarettes) just before going on the ice. Inhaled corticosteroids are used much more now to reduce the inflammation in the lungs– thereby reducing asthma attacks.

Long-acting beta agonists, like salmeterol, reduce the need for "rescue" inhalers like albuterol. They help asthmatics sleep through the night without an asthma attack (wheezing, coughing, shortness of breath). However, some case studies on increased deaths in asthmatics using salmeterol prompted a UK study of 16,000 asthmatics. The study did not statistically show increased risk of death in asthmatics who used salmeterol. So perhaps the study findings were a result of chance.

Hence the SMART study was conducted in 1996 to check the safety of Salmeterol. It ended early in 2003, however, due to increased deaths in African Americans using salmeterol vs. placebo– which was statistically significant (meaning in this study there is less than a 1 percent chance they are wrong).

The START study was supposed to recruit 60,000 subjects to ensure the safety of salmeterol. But only 26,355 subjects were recruited and studied since it ended early. Now, a statistically significant finding occurring way before recruiting all needed subjects is like Tom Cruise winning a Nobel Prize in physics: there is something wrong!

Perhaps the findings resulted from the fact that fewer African Americans were on inhaled steroids. However, all in all, there were more asthma-related deaths in those who used Salmeterol (2.5x) though it was not statistically significant. And looking at the study, if they had been able to recruit all 60,000 subjects, it might become proven to be dangerous.

Remember in Get Smart when the opera singer sang a high note to crack the glass wall, and instead 99's "diamond" ring popped? Like that, in my opinion, the SMART study only raises more questions than answers in its quest to find the truth.

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