Last year Advair's 21 million prescriptions dwarfed the 1.7 million for Serevent, according to IMS Health.
She believes Advair and Serevent cause four of every five asthma-related deaths each year.
Advair's one-two punch seemed ideal: Serevent to expand constricted airways, Flovent to ease inflammation.
Advair, approved by federal regulators in 2000, was more a miracle of marketing than of science.
Yet GlaxoSmithkline never has expressly studied whether Advair, too, might cause a higher death rate in a giant trial.
It wouldn't report any results for several years, and by that time Advair was on the market and roaring.
Compared with steroids alone, using Advair helped only an extra 15% of patients.
The company's huge-selling asthma inhaler, Advair, could face knockoffs in a few years.
Against his doctor's advice, he stopped taking Advair after a week and recovered.
Marcus Faulk of Louisville, Ala. also had a bad reaction to Advair or to Serevent, one of the two drugs it comprises.
Millions of people with asthma use inhalers, like Advair, that give them long-lasting relief from the wheezing, suffocating symptoms of the disease.
She switched to a longer-acting medication, Advair, that better controls her symptoms.
The rampant prescribing of Advair grew a bit more alarming in 2003 when results were released from Glaxo's big safety trial of Serevent.
The FDA has strengthened label warnings for Serevent and Advair three times amid wrangling with the company over how to interpret trial data.
With Advair, "patients get control of their asthma faster, " she maintains.
GlaxoSmithKline, also based in the United Kingdom, has a stable of well-known brands, including respiratory (Advair and Ventolin), antiviral (Combivir) and anxiety (Wellbutrin and Paxil) treatments.
It may be that the presence of the second drug in Advair, the steroid Flovent, quells any threat posed by Serevent (the beta agonist) in many patients.
Yet a Glaxo study in 2004 found that 60% of asthma patients could control their disease with just the inhaled steroid Flovent, the other half of Advair.
Now growing evidence suggests that a small percentage of patients--perhaps 4, 000 people a year, by one doctor's estimate--may be dying because of Advair or its Serevent component.
With the notable exception of a once-a-day successor to asthma inhaler Advair, almost all of the 18 new drugs in late-stage trials are totally new classes of medicines.
Asthma patients taking Advair and other drugs containing salmeterol are advised to monitor their symptoms closely and to have a clear plan to seek help if their symptoms get worse.
Last July an FDA advisory panel, which included Martinez of Arizona, voted unanimously in favor of keeping both Advair and Serevent on the market, although the FDA now says Serevent should never be used on its own.
Thanks to that and Advair's nifty delivery system--a plastic purple puck that is easy to use--the drug has moved far beyond a narrow audience of severe asthma patients to reach those with mild cases and nonasthmatics who simply have a bad bronchial cough.
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