What is the role of Advair Discus (fluticasone-salmeterol) in asthma treatment?

From the Guidelines

Advair Diskus (fluticasone-salmeterol) is a recommended treatment option for patients with persistent asthma whose condition is not adequately controlled with other asthma medications or whose disease severity clearly warrants combination therapy. According to the most recent and highest quality study 1, long-acting beta-agonists (LABAs) such as salmeterol are not to be used as monotherapy for long-term control of asthma, but rather in combination with inhaled corticosteroids (ICSs) like fluticasone. This combination is effective in addressing both major components of asthma: inflammation (through fluticasone) and bronchoconstriction (through salmeterol), making it more effective than either medication alone for patients with persistent asthma symptoms.

Key Points

• Advair Diskus is a combination maintenance medication used to control persistent asthma
• It contains fluticasone, an inhaled corticosteroid, and salmeterol, a long-acting beta-agonist (LABA)
• The medication is typically prescribed for twice-daily use and should not be used for acute asthma attacks or as a rescue medication
• Patients should rinse their mouth after use to prevent thrush, and the medication should be used regularly even when symptoms improve
• The combination of fluticasone and salmeterol is more effective than either medication alone for patients with persistent asthma symptoms, as it addresses both inflammation and bronchoconstriction.

Evidence-Based Recommendation

The recommendation to use Advair Diskus for persistent asthma is based on the most recent and highest quality study 1, which suggests that LABAs should be used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma. This study also notes that increasing the use of short-acting beta-agonists or using them more than two days per week for symptom relief generally indicates inadequate control of asthma and the need to initiate or intensify anti-inflammatory therapy.

Important Considerations

• Patients with mild to moderate persistent asthma treated with inhaled corticosteroids demonstrate improved symptom scores, lower exacerbation rates, and reduced symptom frequency 1
• There are no clinically meaningful differences among the various types of inhaled corticosteroids, and the bronchoprotective effects of inhaled corticosteroids delivered via dry powder inhaler and hydrofluoroalkane-propelled metered dose inhalers are equivalent 1
• Systemic effects of inhaled corticosteroids may occur but typically are not clinically important, except with long-term use 1

From the FDA Drug Label

Peak steady-state fluticasone propionate plasma concentrations in adult subjects with asthma (N = 11) ranged from undetectable to 266 pg/mL after a 500 mcg twice-daily dose of fluticasone propionate inhalation powder using a dry powder inhaler The mean fluticasone propionate plasma concentration was 110 pg/mL. Full pharmacokinetic profiles were obtained from 9 female and 16 male subjects with asthma given fluticasone propionate inhalation powder 500 mcg twice daily using a dry powder inhaler

Advair Discus can be used for asthma. The drug label provides information on the pharmacokinetics of fluticasone propionate and salmeterol in subjects with asthma, indicating that the medication is intended for use in this population. The label also provides data on the plasma concentrations of fluticasone propionate in adult subjects with asthma, which suggests that the medication is effective in this group. 2

From the Research

Role of Advair Discus in Asthma Treatment

• Advair Discus (fluticasone-salmeterol) is a combination inhaler used to treat asthma by delivering a dose of the inhaled corticosteroid (ICS) fluticasone propionate and a dose of the long-acting beta2-adrenergic (LABA) bronchodilator salmeterol 3.
• The combination of ICS and LABA in Advair Discus provides greater asthma control than increasing the ICS dose alone, while reducing the frequency and severity of exacerbations 3.
• Salmeterol added to ICS therapy provides superior asthma control compared to the addition of leukotriene modifiers or theophylline 3.

Efficacy of Advair Discus in Asthma Management

• Studies have shown that salmeterol/fluticasone propionate is effective in improving lung function and symptoms in patients with asthma, and is at least as effective as concurrent salmeterol plus fluticasone propionate 4.
• Salmeterol/fluticasone propionate has been shown to be more effective in improving asthma symptoms than adjusted-dose budesonide/formoterol in patients with uncontrolled asthma despite treatment with inhaled corticosteroids with or without a LABA 4.
• The combination of salmeterol and fluticasone propionate has been shown to provide greater improvements in pulmonary function and symptom control than initiation of maintenance therapy with fluticasone propionate alone 5.

Cost-Effectiveness of Advair Discus

• Pharmacoeconomic analyses have indicated that salmeterol/fluticasone propionate is a cost-effective treatment option for patients with asthma, particularly in those with moderate to severe persistent asthma 6, 4, 7.
• Salmeterol/fluticasone propionate has been shown to be associated with lower asthma-related costs than treatment with other maintenance therapies 6.
• The convenience of the combination product may improve patient adherence and reduce the morbidity of asthma 3.