What's inside salmeterol in prescription Advair which could kill a few asthmatics?

Question

Salmeterol, like formederol, falls under the class of anti-asthma drugs called LABAs...or long-acting beta agonists. But in very few asthmatics, a few who took prescription Advair, which contains salmeterol, died from asthma still. Why is this happening even though Advair was approved by the FDA as an controller medicine for all asthmatics? And what can we do about it?

Answer 1

What an insightful question.  

While salmeterol has reduced medical withdrawals due to asthma control compared with SABA's, it has also been associated with a higher risk for death among patients with severe asthma.

In the most current study of salmeterol vs placebo, salmeterol was associated with slightly higher rates of asthma-related death, respiratory-related death, and the combination of asthma-related deaths, intubation, or mechanical ventilation. This difference largely was confined to African American patients.

Whether this risk is due to factors including but not limited to a physiologic treatment effect, genetic factors, or patient behaviors leading to poor outcomes remains unknown and that is where we are at with this drug.

I guess one would think that the only thing that can be done is a concerted effort to have it withdrawn. But, there is a huge popiulation that this drug is very effective with. So maybe there needs to be a strong re-evaluation to which patient poplation to prescribe the drug to.