Why do some people not tolerate Advair (fluticasone and salmeterol) as well as Symbicort (budesonide and formoterol) powdered inhalers?

From the Guidelines

Some people may not tolerate Advair (fluticasone and salmeterol) as well as Symbicort (budesonide and formoterol) due to differences in the specific medications and their delivery systems. The long-acting beta-agonist component differs between these inhalers - salmeterol in Advair has a slower onset of action (about 30 minutes) compared to formoterol in Symbicort (1-3 minutes) 1. This faster onset may provide quicker symptom relief for some patients. Additionally, the corticosteroid components (fluticasone vs. budesonide) have different pharmacological properties that can affect individual responses. Advair's dry powder formulation contains lactose as a carrier, which may cause issues for those with lactose sensitivity. The delivery devices also differ - Advair's Diskus or HFA inhaler may be more challenging for some patients to use properly compared to Symbicort's Turbuhaler. Individual genetic variations in drug metabolism can also influence how well someone tolerates either medication. If experiencing side effects with Advair such as persistent throat irritation, voice changes, or inadequate symptom control, discussing a switch to Symbicort with a healthcare provider may be beneficial. Key factors to consider when choosing between these medications include the patient's specific symptoms, medical history, and ability to use the inhaler device correctly. It is essential to weigh the potential benefits and risks of each medication and consult with a healthcare provider to determine the best course of treatment. In general, Symbicort may be a better option for patients who require quicker symptom relief and have difficulty using the Advair inhaler. However, the decision to switch medications should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances. Ultimately, the goal of treatment is to achieve optimal symptom control and improve quality of life, while minimizing potential side effects and risks. By carefully considering the available options and consulting with a healthcare provider, patients can make informed decisions about their treatment and work towards achieving the best possible outcomes.

From the FDA Drug Label

Following administration of fluticasone propionate and salmeterol inhalation powder to healthy adult subjects, peak plasma concentrations of salmeterol were achieved in about 5 minutes In 15 healthy subjects receiving ADVAIR HFA 230/21 Inhalation Aerosol (920/84 mcg) and fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg (1,000 mcg/100 mcg), systemic exposure to salmeterol was higher (317 versus 169 pg•h/mL) and peak salmeterol concentrations were lower (196 versus 223 pg/mL) following ADVAIR HFA compared with fluticasone propionate and salmeterol inhalation powder, although pharmacodynamic results were comparable.

The main difference between Advair and Symbicort is the type of inhaled corticosteroid (ICS) and long-acting beta2-agonist (LABA) used.

• Advair contains fluticasone propionate and salmeterol,
• while Symbicort contains budesonide and formoterol. Some people may not tolerate Advair as well as Symbicort due to differences in the pharmacokinetics and pharmacodynamics of these medications, such as the rate of absorption, peak plasma concentrations, and systemic exposure. However, the provided drug labels do not directly address why some people may not tolerate Advair as well as Symbicort. Therefore, the exact reason for the difference in tolerability between Advair and Symbicort is not clear from the provided information 2 2.

From the Research

Tolerance to Advair vs Symbicort Powdered Inhalers

• The tolerance to Advair (fluticasone and salmeterol) versus Symbicort (budesonide and formoterol) powdered inhalers can vary among individuals due to differences in their active ingredients and formulations 3, 4, 5, 6, 7.
• Studies have shown that budesonide/formoterol (Symbicort) can be more effective than salmeterol/fluticasone (Advair) in improving lung function, reducing exacerbations, and improving asthma control in some patients 3, 4, 6.
• The combination of budesonide and formoterol in Symbicort has been shown to have a more favorable safety profile, with a lower risk of hospitalizations and emergency room visits compared to salmeterol/fluticasone (Advair) 6.
• However, other studies have found no significant differences in efficacy and safety between the two treatments, suggesting that individual patient responses may vary 7.
• Factors such as the dose of inhaled corticosteroids (ICS), the type of ICS, and the presence of comorbidities may influence the tolerance to Advair vs Symbicort powdered inhalers 3, 4, 5.

Comparison of Active Ingredients

• Fluticasone (in Advair) and budesonide (in Symbicort) are both ICS, but they have different potencies and pharmacokinetic profiles 3, 4.
• Salmeterol (in Advair) and formoterol (in Symbicort) are both long-acting beta2-agonists (LABAs), but they have different durations of action and receptor binding properties 5, 6.
• The combination of budesonide and formoterol in Symbicort may provide a more rapid onset of action and a more favorable therapeutic ratio compared to salmeterol/fluticasone (Advair) 4, 6.

Clinical Implications

• Healthcare providers should consider individual patient factors, such as asthma severity, comorbidities, and previous treatment responses, when selecting between Advair and Symbicort powdered inhalers 3, 4, 5, 6, 7.
• Patients who experience adverse effects or inadequate control with one treatment may benefit from switching to the other 3, 4, 6.
• Further research is needed to fully understand the differences in tolerance and efficacy between Advair and Symbicort powdered inhalers in various patient populations 7.