What are the recommended doses of ADVAIR (fluticasone and salmeterol) for treating asthma and Chronic Obstructive Pulmonary Disease (COPD)?

Recommended Doses of ADVAIR (Fluticasone and Salmeterol) for Asthma and COPD

For asthma treatment, ADVAIR is recommended at 100/50 mcg, 250/50 mcg, or 500/50 mcg twice daily depending on asthma severity, while for COPD, ADVAIR 250/50 mcg or 500/50 mcg twice daily is recommended based on symptom severity and lung function response.

Dosing for Asthma

ADVAIR combines fluticasone propionate (an inhaled corticosteroid) and salmeterol (a long-acting beta2-agonist) in a single inhaler. The dosing follows a stepwise approach based on asthma severity:

Adults and Adolescents (12 years and older):

• Step 3 (Low-dose ICS + LABA): ADVAIR 100/50 mcg twice daily 1, 2
• Step 4 (Medium-dose ICS + LABA): ADVAIR 250/50 mcg twice daily 1, 2
• Step 5 (High-dose ICS + LABA): ADVAIR 500/50 mcg twice daily 1, 2

Children (4-11 years):

• ADVAIR 100/50 mcg twice daily 2, 3
• Clinical trials have demonstrated that this dose is safe and effective for children in this age group 3

Dosing for COPD

For patients with COPD, ADVAIR is available in two strengths:

• ADVAIR 250/50 mcg: One inhalation twice daily 3
• ADVAIR 500/50 mcg: One inhalation twice daily 3

The choice between these doses should be based on:

1. Severity of airflow limitation
2. History of exacerbations
3. Response to therapy

Clinical trials have shown that both doses significantly improve lung function compared to placebo, with improvements in FEV1 of 133 mL over placebo 4.

Clinical Considerations for Dosing

For Asthma:

• Start at the appropriate step based on asthma severity
• Assess control after 2-4 weeks
• Step up if inadequate control (symptoms >2 days/week, nighttime awakenings, or rescue medication use >2 days/week) 1, 2
• Once control is achieved for at least 3 months, consider stepping down to the lowest effective dose 2

For COPD:

• Objective improvement should be documented (FEV1 improvement ≥10% predicted and/or >200 mL) to justify continued use 1
• For high doses (≥1,000 μg/day of fluticasone), use a large-volume spacer or dry-powder system 1, 2

Important Safety Considerations

• ADVAIR should never be used as monotherapy for asthma; it contains a LABA (salmeterol) which should only be used in combination with an ICS 1
• Patients should be instructed to rinse their mouth after using ADVAIR to reduce the risk of oral candidiasis 2
• For patients with asthma, ADVAIR has been shown to reduce exacerbations compared to fluticasone alone, with a hazard ratio of 0.79 (95% CI: 0.70,0.89) 3
• For COPD patients, ADVAIR reduces the risk of hospitalizations/emergency room visits compared to individual components 4

Common Pitfalls to Avoid

1. Inappropriate monotherapy: Never prescribe ADVAIR as initial therapy for mild persistent asthma; step-up from ICS alone 1
2. Inadequate monitoring: Failure to assess response and adjust therapy accordingly
3. Missing comorbidities: Not addressing conditions that may worsen asthma or COPD control
4. Overreliance on rescue medications: If a patient uses rescue medications >2 days/week, this indicates inadequate control and need to step up therapy 1
5. Not instructing patients on proper inhaler technique: This can significantly reduce medication delivery and efficacy 1

By following these dosing recommendations and clinical considerations, you can optimize the use of ADVAIR to improve lung function, reduce symptoms, and decrease exacerbation risk in patients with asthma and COPD.