Advair (fluticasone propionate and salmeterol)

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Advair (fluticasone propionate and salmeterol) is a combination inhaler that has an inhaled corticosteroid and a long-acting beta agonist (abbreviated: LABA). Advair comes as a dry powder inhaler (Advair Diskus) and metered dose inhaler (Advair HFA).1,2  Advair Diskus is approved for the treatment of asthma for people ages four years and up, as well as COPD (chronic obstructive pulmonary disease). Advair HFA is only approved for asthma for people ages 12 years and up. It is made by GlaxoSmithKline.

Do not take Advair if you are having an asthma attack.1,2 It does not work quickly enough. Use a rescue inhaler (short-acting beta agonist) instead.

How does Advair work?

Advair contains two medications. Fluticasone propionate is an inhaled corticosteroid.1,2 This medication reduces inflammation in the airways. Corticosteroids affect many different types of inflammatory cells, including eosinophils and mast cells. They also affect signaling chemicals that have a role in inflammation such as histamine, leukotrienes, and cytokines.

Salmeterol is a LABA. This medication relaxes the muscles that surround the airways.1,2 This helps the airways to open up. Salmeterol also prevents mast cells from sending out chemical signals that increase inflammation. This makes the airways less sensitive (“hyperresponsive”).

How is Advair Diskus taken?

Ask your health care provider or respiratory therapist to show you how to use your inhaler properly.

Advair Diskus is a purple dry powder inhaler.1 It comes in three strengths: 100 mcg, 250 mcg, and 500 mcg fluticasone propionate, which are combined with 50 mcg salmeterol. One inhalation should be taken two times per day (Table 1).3 The inhalations should be about 12 hours apart and at the same time each day. For example, you might take Advair at 8 am and 8 pm.

Table 1. Using your Advair Diskus

The steps for using your Advair Diskus are:

  1. Hold your Diskus in your left hand in a flat, level position.
  2. Open the Diskus: Place your right thumb in the thumb grip and push the thumb grip away from you as far as it will go. The mouthpiece will show and snap into place.
  3. Slide the lever away from the mouthpiece as far as it will go until it clicks.
  4. Check that the number on the counter has decreased by 1.
  5. Turn away from the Diskus and breathe out until your lungs are empty. (If you breathe into the Diskus, you will lose the dose of medicine.)
  6. Put your lips on the mouthpiece. Breathe in quickly and deeply through your mouth. (You may not feel or taste the medicine. Do not take another dose.)
  7. Remove the Diskus from your mouth. Hold your breath for about 10 seconds. Then breathe out slowly.
  8. Slide the Diskus closed.
  9. Rinse your mouth with water and spit out the water. This step will help to prevent thrush, a fungal infection of the mouth.
Tip

  • Read the Patient Information that comes with your inhaler for complete instructions.

Advair Diskus® [patient information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.

How is Advair HFA taken?

Ask your health care provider or respiratory therapist to show you how to use your inhaler properly.

Advair HFA is a purple metered dose inhaler.2 It comes in three strengths: 45 mcg, 115 mcg, and 230 mcg fluticasone propionate, which are combined with 21 mcg salmeterol. Two puffs should be taken twice daily, about 12 hours apart and at the same time each day (Table 2).4

Before using the inhaler for the first time, you have to prime it.4 To prime the inhaler, shake it for five seconds. Turn the inhaler away from you and press the canister down, releasing one puff into the air. Shake and spray your inhaler three more times. You have to prime it again if you have not used the inhaler for four weeks or have dropped it. In this case, shake for five seconds and spray the inhaler; repeat one more time.

Table 2. Using your Advair HFA metered dose inhaler.

The steps for using your Advair HFA metered dose inhaler are:

  1. Shake the inhaler for 5 seconds.
  2. Breathe out until your lungs are empty.
  3. Put the mouthpiece in your mouth and close your lips around it.
  4. Begin to breathe in deeply and slowly through your mouth. Push the canister down to release a “puff” as you breathe in. After the spray comes out, lift your finger off the canister.
  5. After you have inhaled fully, take the inhaler out of your mouth. Keep your mouth closed and hold your breath for 10 seconds before exhaling slowly.
  6. Wait 30 seconds. Shake the inhaler again and repeat one more time.
  7. Rinse your mouth with water and spit out the water. This step will help to prevent thrush, a fungal infection of the mouth.
Tips

  • Read the Patient Information that comes with your inhaler for complete instructions.
  • The inhaler is best used at room temperature.
  • You can use a spacer or valved holding chamber with a metered dose inhaler. These devices help the medications to get into your lungs.

Advair ® HFA [patient information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.

What should I do if I miss a dose of Advair?

If you miss a dose of Advair, just skip that dose.3,4 Take the next dose at the regular time. Do not take two doses at once.

What are the recommendations for storing, cleaning, and discarding Advair?

Advair Diskus comes in a foil pouch.1 Store the unopened pouch until the first use. Keep the Advair Diskus at room temperature (68˚F and 77˚F) in a dry place, away from sunlight or heat. Do not take your Diskus apart or try to wash it.3 Throw the Diskus away when the counter reads 0. You have used all the medication in it.

Advair HFA comes in a purple plastic inhaler with a separate metal canister containing the medication.2  Do not use the Advair inhaler with other medications. Do not use other inhalers with the Advair canister. Leave the canister in the inhaler while cleaning.4 Once a week, wipe the small hole where the medicine comes out with a clean cotton swab. Wipe the mouthpiece with a clean, damp tissue. Allow it to air dry. Throw away the canister and inhaler when the counter reads 000. You have used all the medication. Store your Advair HFA at room temperature (68˚F and 77˚F).1 Avoid high heat or flames.

What are the risks of taking Advair?

One of the medications in the Advair inhaler is salmeterol, a LABA. In large studies, people who took salmeterol had an increased risk of asthma-related death.1,2 In these studies, there were 13 deaths out of 13,176 people who took salmeterol, compared with three deaths out of 13,179 people who took a fake medication (placebo). Children and adolescents who take LABAs have a higher risk of hospitalization.

The US Food and Drug Administration says that LABAs should only be used with second medication, such as an inhaled corticosteroid.5 Advair contains both a LABA and an inhaled corticosteroid. Trials are underway to study LABAs as part of a combination treatment.6 Currently, it is not known whether taking a LABA with an inhaled corticosteroid decreases the risk of asthma-related death.1,2

What are the possible side effects of taking Advair?

Taking Advair could cause your airways to tighten suddenly (“bronchospasm”).1,2 This side effect can happen right after using the inhaler. Take your rescue inhaler and call your health care provider.

Common side effects of using Advair are colds, sore throat, hoarseness, breathing problems, cough, headache, dizziness, nausea, and vomiting.3,4 Salmeterol, one of the medications in Advair, can cause increased heart rate, high blood pressure, chest pain, tremor, or nervousness.

Inhaled corticosteroids, such as fluticasone propionate, can cause thrush, a fungal infection in your mouth.3,4 You can help to prevent this by rinsing your mouth with water after using the inhaler and spitting out the water.

Corticosteroids can lower your immune system, so you are more likely to get an infection or pneumonia.3,4 Avoid contact with people who have chickenpox, measles, or other contagious diseases. Tell your provider if you have any infections, including tuberculosis or herpes simplex of the eye.

Children who use corticosteroids may grow more slowly.3,4 Your child’s growth should be checked regularly.

Are there people who should not take Advair?

Do not take Advair if you are having an asthma attack.1,2 Advair does not work quickly enough. Use a rescue inhaler instead.

People taking another LABA should not take Advair.1,2 If your asthma can be controlled with a low- or medium-dose inhaled corticosteroid alone, you also should not take Advair.

People with a severe milk allergy should not use the Advair Diskus.3 If you are allergic to any ingredient in Advair, you should not take this medication.3,4

Tell your health care provider if you have had problems with your heart, eyes, immune system, thyroid, or liver.3,4 You should also tell your provider if you have high blood pressure, seizures, diabetes, or osteoporosis. Taking corticosteroids or LABAs may worsen these conditions. Extra monitoring or an alternative treatment may be needed.  Tell your health care provider about any prescription medications you take, particularly LABAs, oral corticosteroids, antifungals, or anti-HIV medications. Let your provider know about over-the-counter medications or supplements that you take.

Advair has not been well studied in pregnant or breastfeeding women.3,4 Little is known about whether this medication passes into breast milk. Talk to your doctor about if you become pregnant or wish to breastfeed while taking Advair.

What evidence do we have that Advair works?

Advair Diskus was compared with fluticasone propionate and salmeterol alone and with a fake treatment (placebo).1 Three high-quality studies were done in adolescents and adults whose asthma was not well controlled with their current therapy. These studies included 1,208 people. The results showed that people taking Advair 100/50 and 250/50 had better lung function. Their quality of life was better. Fewer people treated with Advair had to withdraw from the trial because their asthma got worse. The study of the 500/50 dose was designed differently. It showed that Advair improved peak expiratory flow in the morning better than fluticasone propionate alone. It also showed that taking the medications in one inhaler was as effective as taking them in separate inhalers. A study of 203 children showed that Advair Diskus is safe for children ages four to 11 years.

Studies indicate that Advair HFA is as effective as Advair Diskus.2 Advair HFA was studied in four high-quality studies of 1,517 adults and adolescents. The people in this study were using a range of medications, from as-needed inhalers to daily inhaled corticosteroids or LABAs before the study started. Lung function improved more with Advair HFA (45/21 and 115/21 doses) than fluticasone alone, salmeterol alone, or placebo. People treated with Advair HFA had fewer asthma symptoms and used less rescue medication. A head-to-head comparison showed that Advair HFA 230/21 is as effective as Advair Diskus 500/50, and both are more effective than fluticasone alone.

Is there a generic alternative to Advair?

There is no generic alternative to Advair. The two medications in Advair are available separately. Fluticasone propionate is marketed as Flovent. Salmeterol is marketed as Serevent. Neither is available in generic form to treat asthma.

view references
  1. Advair Diskus® [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.
  2. Advair ® HFA [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.
  3. Advair Diskus® [patient information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.
  4. Advair ® HFA [patient information]. Research Triangle Park, NC: GlaxoSmithKline; 2014.
  5. US Food and Drug Administration. Drug labels now contain updated recommendations on the appropriate use of long-acting inhaled asthma medications called long-acting beta-agonists. Accessed 2/15/15 at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213836.htm
  6. US Food and Drug Administration. FDA requires post-market safety trials for Long-Acting Beta-Agonists (LABAs). Accessed 2/15/15 at: http://www.fda.gov/Drugs/DrugSafety/ucm251512.htm.
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