Advair (Fluticasone Propionate and Salmeterol) Dosing Guidelines
Advair should be administered twice daily with the specific dose determined by age, condition severity, and formulation type.
Dosing Recommendations by Age and Condition
Adults and Adolescents (≥12 years)
Asthma:
- Mild persistent: Advair Diskus 100/50 mcg (fluticasone 100 mcg/salmeterol 50 mcg) twice daily
- Moderate persistent: Advair Diskus 250/50 mcg twice daily
- Severe persistent: Advair Diskus 500/50 mcg twice daily 1
COPD:
- Advair Diskus 250/50 mcg twice daily (US approval)
- Advair Diskus 500/50 mcg twice daily (EU approval for severe COPD) 2
Children (4-11 years)
- Asthma:
- Advair Diskus 100/50 mcg twice daily
- May increase to 250/50 mcg twice daily for moderate-severe asthma 1
Children (<4 years)
- Not recommended
Administration Instructions
Proper Technique:
- Use at the same time each day, approximately 12 hours apart
- Rinse mouth after use to prevent oral thrush
- For children, use with a spacer or valved holding chamber 1
Duration and Monitoring:
- Assess efficacy within 4-6 weeks of starting treatment
- Consider step-down therapy after 3 months of stable control 1
- Monitor for side effects including cough, dysphonia, and oral thrush
Clinical Considerations
Advantages of Combination Therapy
- Combined salmeterol/fluticasone is more effective than either component alone at the same dosage 3, 4
- Provides better symptom control and improved lung function compared to monotherapy 4
- May reduce the need for rescue medications and improve quality of life
Precautions
- Never use as rescue medication for acute symptoms
- Do not exceed recommended dosage
- Tachyphylaxis to the bronchoprotective effect may occur with regular use of long-acting beta agonists 5
- Monitor growth in pediatric patients on high doses 1
Common Side Effects
- Headache, throat irritation, hoarseness, and oral candidiasis 3
- Systemic effects are rare at recommended doses but may occur with long-term high-dose use 5
Dose Adjustments
- For patients not adequately controlled on current dose, consider stepping up to the next higher strength
- For patients with stable control for ≥3 months, consider stepping down by 25-50% at each step 5
- When switching from separate inhalers, start with the equivalent dose of fluticasone in the combination product
Advair combines the benefits of both a long-acting bronchodilator and an inhaled corticosteroid, providing effective control of persistent asthma and COPD symptoms with a convenient twice-daily dosing schedule.