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Published by: AsmphLibrary Ortigas on Nov 28, 2012
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November 2012
PhilHealth signs MOAwith pharma
Vaccinaon the key toglobal health
Managing HFMD in
primary care
Crater culture
Step-off approach to LABA asthmatherapy under scrutiny 
November 2012
Step-off approach to LABA asthma therapy under scrutiny 
Elvira Manzano
he approach of discontinuing long-act-ing
2-agonist (LABA) therapy (‘step-
o’ therapy) in patients who achieve
control of their symptoms on a combination ofLABA and inhaled corticosteroids (ICS) maylead to exacerbation of symptoms and reduce
quality of life, according to new research.A meta-analysis of ve randomized con
trolled trials comparing step-o therapy with
continued use of LABA and inhaled ICS medi-
cations found that the LABA step-o approachwas linked to a rise in asthma-related impair
ment. Compared with patients who contin
ued combination therapy, those who stoppedtreatment had fewer symptom-free days (608vs. 622) and lower scores on questionnairesassessing quality of life and overall asthmacontrol. They also required an average of 0.71(95% CI 0.29 to 1.14) more pus per day of arescue bronchodilator and had a non-signi
-cant increase in use of oral corticosteroids (RR
1.68, 95% CI 0.84–3.38). There were no deathsand too few exacerbations in the studies toevaluate safety outcomes. [
 Arch Intern Med
2012; DOI:10.1001/archinternmed.2012.3250]The ndings contradict the US Food andDrug Administration’s (FDA) ‘black box’warning that LABAs, when given with ICS,
should be discontinued as soon as asthma
control is achieved.“In contrast to FDA recommendations, our
analysis supports the continued use of LA-BAs to maintain asthma control,” said study
author Dr. Jan L. Brozek from the department
of clinical epidemiology and biostatistics and
medicine, McMaster University, Hamilton,Ontario, Canada.
Manufacturers of LABAs are conduct-ing further large-scale safety studies of their
products, however the results of these will not be available for 5 years. “In the interim, theconsistent trends that we identied for manyasthma impairment factors, some of whichwere statistically signicant, favor the contin
ued use of LABAs,” said Brozek.Brozek and his fellow investigators cau
tioned that the studies were of short durationand had high withdrawal rates. Nevertheless,“our ndings likely represent the current bestevidence about stepping o LABA therapy inpatients with asthma.”While there is consensus that LABAs haveno role in asthma monotherapy, the ndingshelp shi the burden of proof in the debateover stepped-down withdrawal of LABAs,wrote Dr. Chee M. Chan and Dr. Andrew F.Shorr, from the division of pulmonary andcritical care medicine at Washington HospitalCenter, Washington D.C., US, in an accompa
nying commentary.Moreover, they called on the FDA to recon
sider the ‘black box’ warning for these agents based on the ndings. “We hope that thismeta-analysis helps to li some of the black
clouds in the debate surrounding LABAs,”
they said. “Similarly, physicians must nowreevaluate the contents of the black box forLABAs, particularly in individuals whoseasthma is well-controlled with combinationLABA and ICS therapy.”
November 2012
Alexandra Kirsten
elebrities can help to promote public
health and are eective in doing so, saysa public health expert in Australia.While celebrities are not always health ex
perts, unlike many health experts, they “of
ten speak personally and bring compellingauthenticity to public discourse,” wrote Dr.
Simon Chapman, professor of public health
at the University of Sydney, Australia, in a
recent editorial published in the
British Medi-cal Journal
. [
2012;345 DOI: hp://dx.doi.org/10.1136/bmj.e6364]
Critics of celebrities in health campaigns
point to examples which have gone “badlywrong.” They focus on celebrity endorsementof “aky complementary medicine and quackdiets” or incidents where celebrities haveveered away from the message.On the contrary, Chapman suggests there
are many examples of celebrity engagement
that have amplied news coverage about
important neglected problems or celebrity
involvement in campaigns to promote evi
dence-based health policy reform.Talking about the case of Australian crick
eter Shane Warne, who accepted a six-gure
sum to use nicotine replacement therapy to
quit smoking, Chapman said “we should notexpect perfect outcomes aer celebrity en
-gagement and need to be realistic about theneed to sustaining public campaigns beyond
their rst burst.”
When photographs appeared of the sports-
man smoking again, many experts “failed
to exploit” the important message about the
risks of relapsing, said Chapman, “insteadclimbing on a cynical populist bandwagonabout his alleged motives.”He also mentioned Australian singer Ky
lie Minogue’s breast cancer, which “led to anincrease in unscreened women in the targetage range having mammography, but alsoto an increase in young women at very lowrisk seeking mammograms and thus being
exposed to unnecessary radiation and false-
positive investigations.”The ambivalence about this eect reectsthe debate about the wisdom of breast cancer
screening, he said, “but it should not blind
us to the potential value of celebrity engage
ment in important causes.”In response to Chapman’s comments, Dr.Geof Rayner, former chair of the UK PublicHealth Association and Honorary ResearchFellow at City University London, England,said he remains concerned about the inuenc
es of celebrities who dabble in the public healtharena. While celebrities might help to boost
campaigns in the short term, Rayner said they“must tread a cautious path of support because
of the risk that the celebrity becomes the story,not the campaign.” [
2012;345 DOI: hp://dx.doi.org/10.1136/bmj.e6362]Certainly celebrities help shi products,
 but according to Rayner this “has become
mainstream marketing strategy” across so
ciety, even in politics. Rather than relying
on media stunts, modern health campaign-
ers “need to go on the oensive against junkfood, alcohol, gambling, and other oencelebrity linked, commercial propaganda.”Rayner postulated new measures to promote
public health, for example campaign groups
that “bring together the lobbying power of
thousands of ordinary people through the
internet.”“Some celebrities might help, but let’s notlook for saviours, buoyed by the happy thoughtthat the work is done when a celebrity is in
volved. That’s a lie too”, Rayner concluded.
Do celebrities help public health campaigns?

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