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We have received the response from Dr. William Busse, which is noted below.
Thank you again for your inquiry, and we hope this is helpful to you.
Response from Dr. William Busse:
When we revised the Guidelines, we removed the use of oral beta agonists from the treatment plan. The change in policy was based on an absence of evidence that oral products add anything over inhaled products. We were also aware that oral beta agonists may have increased side effects such as tremor, etc. There has not been, to my knowledge, a safety issue, but rather one of efficacy and effectiveness.
In children there still remains the use of oral products because options for inhaled equivalents does not always exist.
William W. Busse, M.D.
George R. and Elaine Love Professor
Chair, Department of Medicine
Sincerely,
Phil Lieberman
Thank you for your recent inquiry.
I have not seen long-acting inhaled beta-agonists combined with oral sustained release beta-agonists used in the therapy of asthma; nor have I personally interpreted our most recent guidelines to endorse the simultaneous use of these two drugs while "titrating to clinical stability." However, as you know, the guidelines are a fairly mammoth document, and I therefore am going to seek another opinion in this regard. I will ask Dr. Bill Busse, who is an internationally known authority in asthma management, and who participated in the authorship of the guidelines, to respond as well to your question. When I receive Dr. Busse's comments, I will forward them to you.
Thank you again for your inquiry and we hope this response is helpful to you.
Sincerely,
Phil Lieberman, M.D.
7205 Wolf River Boulevard, Suite 200
Germantown, TN 38138
Telephone: 901-757-6100
Fax: 901-757-6109
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