What is the recommended dosing for Advair (fluticasone-salmeterol) in adults and adolescents with asthma or Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

For adults and adolescents with asthma or Chronic Obstructive Pulmonary Disease (COPD), Advair (fluticasone-salmeterol) is typically prescribed as one inhalation twice daily, approximately 12 hours apart, with the specific strength depending on the severity of the condition. The recommended dosing for Advair in adults and adolescents with asthma or COPD can vary based on the severity of the disease and the specific formulation of the medication.

• For asthma, Advair Diskus comes in 100/50 mcg, 250/50 mcg, or 500/50 mcg strengths, while Advair HFA is available in 45/21 mcg, 115/21 mcg, or 230/21 mcg strengths 1.
• For COPD patients, the recommended dose is one inhalation of Advair Diskus 250/50 mcg twice daily 1. Patients should rinse their mouth with water after each use without swallowing to prevent oral thrush, a common side effect.
• The medication should be used regularly even when symptoms improve, as it combines a corticosteroid (fluticasone) to reduce airway inflammation and a long-acting beta-agonist (salmeterol) to relax airway muscles 1.
• Advair is not for rescue treatment of acute symptoms and should be part of a comprehensive treatment plan.
• Improvement may begin within 30 minutes, but maximum benefits typically develop over 1-2 weeks of regular use. It's worth noting that the most recent and highest quality study, from 2016, recommends maintenance combination inhaled corticosteroid/long-acting beta-agonist for patients with stable moderate, severe, and very severe COPD 1.

From the Research

Advair Dosing for Asthma and COPD

The recommended dosing for Advair (fluticasone-salmeterol) in adults and adolescents with asthma or Chronic Obstructive Pulmonary Disease (COPD) is as follows:

• For asthma, the Advair Diskus is available in 3 strengths of fluticasone propionate (100,250, and 500 microg) and a fixed dose (50 microg) of salmeterol, taken twice daily 2.
• The novel fluticasone propionate/salmeterol multidose dry powder inhaler (MDPI) (AirDuo RespiClick®) is available in low-, mid- and high-dosage formulations (55/14,113/14 and 232/14 μg, respectively) for twice-daily treatment of asthma in patients aged ≥ 12 years 3.
• Salmeterol/fluticasone propionate maintenance therapy improves lung function and asthma symptoms to a greater extent than monotherapy with inhaled corticosteroids (ICS) or other treatments, and is generally well tolerated in adults, adolescents and children aged 4-11 years 4.

Dosing Considerations

Some key considerations for dosing Advair include:

• The Global Initiative for Asthma guidelines recommend daily maintenance doses of 100 to 250 μg, >250 to 500 μg, and >500 μg of fluticasone propionate or equivalent for adults with asthma, but it has been proposed that this terminology is not evidence-based and may lead to excessive doses of ICS 5.
• A meta-analysis found that adding salmeterol to moderate doses of ICS (fluticasone propionate 200 μg/day or equivalent) results in significantly greater clinical benefit than increasing the dose of ICS by twofold or more 6.
• The dose of ICS at which to start concomitant long-acting beta agonist (LABA) treatment in patients with asthma not adequately controlled by ICS alone is uncertain, but it has been suggested that a standard daily dose of 200-250 μg of fluticasone propionate or equivalent may be appropriate 5.