From the Guidelines
The use of both Qvar (beclomethasone dipropionate) and Advair HFA (fluticasone-salmeterol) can be medically justified in certain situations, such as severe or difficult-to-control asthma, where the benefits of combination therapy outweigh the risks of increased side effects.
Medical Rationale
The medical rationale for using both Qvar and Advair HFA is based on the fact that they have different mechanisms of action and can provide additive benefits in controlling asthma symptoms. Qvar is an inhaled corticosteroid (ICS) that reduces airway inflammation, while Advair HFA contains both an ICS (fluticasone) and a long-acting beta-agonist (salmeterol) that provides bronchodilation for up to 12 hours 1.
Key Considerations
Some key considerations when using both Qvar and Advair HFA include:
- The potential for increased side effects, such as oral thrush, voice changes, and potential systemic effects like adrenal suppression with long-term use 1
- The need for close medical supervision and regular reassessment of the necessity and effectiveness of the dual-ICS regimen
- The importance of optimizing one combination therapy before adding additional medications, as recommended by most asthma treatment guidelines 1
Patient Selection
This combination therapy would typically be prescribed for patients with severe or difficult-to-control asthma who need multiple controller medications. The decision to use both Qvar and Advair HFA should be made on a case-by-case basis, taking into account the individual patient's medical history, asthma severity, and response to previous treatments.
Monitoring and Adjustments
Regular monitoring of asthma symptoms, lung function, and potential side effects is crucial when using both Qvar and Advair HFA. Adjustments to the treatment regimen may be necessary to minimize side effects and optimize asthma control.
From the Research
Medical Justification for Using Qvar and Advair HFA
The use of both Qvar (beclomethasone dipropionate) and Advair HFA (fluticasone-salmeterol) can be justified medically based on the following points:
- Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, and the combination of ICS and long-acting beta2-agonists (LABAs) has been shown to be effective in controlling asthma symptoms 2.
- The combination of beclomethasone dipropionate and salmeterol, or fluticasone propionate and salmeterol, has been shown to have at least the same efficacy as doubling the dose of the ICS in adults 2.
- Fixed-dose combinations of ICS/LABA, such as fluticasone propionate and salmeterol, are commonly prescribed for asthma and chronic obstructive pulmonary disease (COPD) 3.
- Stepping down with a combination inhaler, such as fluticasone-salmeterol, can confer further improvements in bronchoprotection, bronchodilatation, and clinical control compared to a medium dose of inhaled corticosteroid alone 4.
- Single inhaler combination regimens, such as budesonide/formoterol and fluticasone/salmeterol, are frequently more effective in improving treatment outcomes than either monotherapy alone 5.
Key Findings
Key findings from the studies include:
- Qvar (hydrofluoroalkane-beclomethasone extrafine inhalation aerosol) has been shown to be effective in controlling asthma symptoms with a lower dose than traditional chlorofluorocarbon (CFC)-containing inhalers 6.
- The combination of fluticasone propionate and salmeterol has been shown to be effective in improving lung function, symptom-free days, and reducing asthma exacerbations 5.
- The use of a single inhaler combination regimen can improve treatment compliance and outcomes 2, 5.
Treatment Outcomes
Treatment outcomes that support the use of both Qvar and Advair HFA include:
- Improved lung function
- Increased symptom-free days
- Reduced use of rescue medications
- Decreased asthma exacerbations
- Improved quality of life