1. Sofer, Dalia

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While inhaled corticosteroids are the preferred treatment for asthma, many patients who don't respond adequately to corticosteroids also receive long-acting [beta]-agonists. But a recent metaanalysis examining 19 studies with a total of 33,826 participants reveals that children and adults taking long-acting [beta]-agonists are more likely to be hospitalized or to die than are those taking placebo. Of the three medications examined-salmeterol, formoterol, and eformoterol-the former two were found most harmful; salmeterol, say the researchers, may be responsible for as many as 4,000 out of the 5,000 asthma-related deaths occurring each year in the United States.


In July 2005, after several reported deaths associated with the use of salmeterol, the U.S. Food and Drug Administration (FDA) considered removing [beta]-agonists from the market, but opted to impose mandatory black box warnings on their labels, accompanied by the recommendation that they be used as a last recourse only. The warnings, the researchers assert, have gone unheeded; prescriptions continue to be written by physicians at the rate they had been prior to the FDA measures. The authors suggest that the question of whether to withdraw these medications from the market should be revisited in light of these findings.


Dalia Sofer


Salpeter SR, et al. Ann Intern Med 2006;144(12):904-12.



Eating leafy green vegetables may prevent bone loss and fractures in those at risk, conclude the authors of a metaanalysis of randomized controlled trials of the effects of vitamin K supplementation. The report, published in the June 26 issue of the Archives of Internal Medicine, reviewed 13 trials, mostly conducted in Japan on postmenopausal women and using menaquinone-4 as the vitamin K supplement. Study participants who received the supplement were significantly less likely to suffer a fracture than those who did not. The only adverse effect reported was mild gastrointestinal symptoms. Because of study limitations-many studies were of low quality and the effect of vitamin K on fracture rates was found to be larger than in previous studies, suggesting that an unidentified factor influenced outcomes-the authors caution against routine vitamin K supplementation until a large, randomized clinical trial has been performed.