Is Advair (fluticasone-salmeterol) appropriate for a teenager?

From the Guidelines

Advair can be an appropriate treatment option for teenagers with moderate to severe persistent asthma, as recommended by the 2020 focused updates to the NIH asthma management guidelines 1. The medication combines fluticasone, a corticosteroid, and salmeterol, a long-acting beta-agonist, to help control asthma symptoms and prevent exacerbations. For teenagers with moderate to severe persistent asthma that is not well-controlled with other medications, Advair may be prescribed, with the typical starting dose being Advair 100/50 (100 mcg fluticasone and 50 mcg salmeterol) inhaled twice daily, but this can vary based on asthma severity and individual response. Some key points to consider when prescribing Advair to teenagers include:

• The importance of using the lowest effective dose for the shortest duration necessary to maintain asthma control, as recommended by the NIH guidelines 1.
• The need for regular check-ups with a healthcare provider to monitor effectiveness and potential side effects, such as growth suppression and increased risk of asthma-related death in some patients.
• The consideration of alternative treatment options, such as leukotriene receptor antagonists, for mild persistent asthma, as discussed in the 2010 update on medical therapy for asthma 2.
• The potential benefits and risks of using Advair, including its ability to reduce airway inflammation and relax airway muscles, providing both immediate and long-term asthma control, as well as its potential side effects, as outlined in the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 3.

From the FDA Drug Label

8.4 Pediatric Use Use of fluticasone propionate and salmeterol inhalation powder 100 mcg/50 mcg in patients aged 4 to 11 years is supported by extrapolation of efficacy data from older subjects and by safety and efficacy data from a trial of fluticasone propionate and salmeterol inhalation powder 100 mcg/50 mcg in children with asthma aged 4 to 11 years ICS, including fluticasone propionate, a component of Wixela Inhub®, may cause a reduction in growth velocity in children and adolescents

Advair (fluticasone-salmeterol) can be used in teenagers, but it is essential to monitor their growth velocity due to the potential for reduction caused by inhaled corticosteroids, including fluticasone propionate. The safety and effectiveness of fluticasone propionate and salmeterol inhalation powder in children with asthma younger than 4 years have not been established 4.

From the Research

Efficacy and Safety of Advair for Teenagers

• The provided studies do not directly address the appropriateness of Advair (fluticasone-salmeterol) for teenagers 5, 6, 7, 8, 9.
• However, study 8 mentions that it is cost-effective to use Advair for patients 12 years and over compared to doubling their fluticasone propionate dose, suggesting that Advair may be suitable for teenagers with uncontrolled asthma.

Asthma Treatment Guidelines

• Asthma treatment guidelines advocate the use of long-acting beta2-agonists (LABA) in addition to inhaled corticosteroids (ICS) in patients whose asthma is uncontrolled by ICS alone 7.
• The combination of ICS and LABA, such as fluticasone propionate and salmeterol, provides superior control of asthma symptoms and reduces the frequency of exacerbations 5, 7.

Safety Profile

• The safety profile of Advair is similar to that of its constituent medications, with the most common drug-related adverse events being those known to be attributable to ICS therapy and/or LABA therapy 5.
• No new safety-related issues have been identified with ICS/LABA combination therapy compared to the monocomponents 7.