What is an alternative inhaler to fluticasone-salmeterol (Advair) 115-21?

Alternative Inhalers to Fluticasone-Salmeterol 115-21

For patients currently using fluticasone-salmeterol (Advair) 115-21, appropriate alternative inhalers include budesonide-formoterol (Symbicort), mometasone-formoterol (Dulera), or fluticasone-vilanterol (Breo Ellipta) as these provide similar combination therapy with an inhaled corticosteroid and long-acting beta-agonist.

Understanding Fluticasone-Salmeterol 115-21

Fluticasone-salmeterol 115-21 is a combination inhaler containing:

• Fluticasone propionate (an inhaled corticosteroid or ICS)
• Salmeterol (a long-acting beta2-agonist or LABA)

This combination targets both the inflammatory and bronchoconstrictive components of asthma or COPD 1.

Appropriate Alternative Combination Inhalers

First-Line Alternatives

When switching from fluticasone-salmeterol, the following combination inhalers are appropriate alternatives:

• Budesonide-formoterol (Symbicort)

  • Contains a different ICS (budesonide) and LABA (formoterol)
  • Available in various strengths to match treatment intensity 2
  • Provides similar anti-inflammatory and bronchodilator effects 2

• Mometasone-formoterol (Dulera)

  • Contains mometasone (ICS) and formoterol (LABA)
  • Provides comparable control of respiratory symptoms 2

• Fluticasone-vilanterol (Breo Ellipta)

  • Contains fluticasone furoate (ICS) and vilanterol (LABA)
  • Once-daily dosing which may improve adherence 2

Alternative Delivery Systems

If the patient prefers to stay with the same medication but needs a different delivery system:

• Fluticasone-salmeterol in a different device
  • Available in various delivery systems (Diskus, MDI, Easyhaler)
  • Studies show that switching between devices with the same medication can maintain or improve control 3

Selection Algorithm Based on Clinical Factors

1. For patients with poor inhaler technique:

   • Consider devices that are easier to use (e.g., breath-actuated or those requiring less coordination) 2

2. For patients with adherence concerns:

   • Consider once-daily formulations like fluticasone-vilanterol 2

3. For patients with severe disease:

   • Ensure the alternative provides equivalent or higher potency of ICS component 2

4. For patients with frequent exacerbations:

   • Combination therapy with ICS/LABA has been shown to reduce exacerbation rates compared to monotherapy 2

Important Clinical Considerations

• Maintain ICS component: Never switch to LABA monotherapy as this increases risk of severe exacerbations and mortality 2

• Dose equivalence: When switching between different ICS medications, ensure appropriate dose equivalence to maintain asthma control 2

• Patient education: Proper inhaler technique with the new device is essential for therapeutic efficacy 3

• Monitoring after switch: Assess symptom control, lung function, and exacerbation frequency after switching to ensure the alternative is effective 2

Common Pitfalls to Avoid

• Avoiding step-down too quickly: Maintain the same relative treatment intensity when switching between combination inhalers 2

• Ignoring device preferences: Patient comfort and ability to use the device correctly significantly impacts treatment success 3

• Overlooking drug interactions: Some patients may have specific contraindications to certain combinations 4

• Neglecting comorbidities: Consider conditions like cardiovascular disease when selecting beta-agonist components 4

The choice of alternative inhaler should be based on maintaining or improving asthma control while considering factors such as device usability, dosing frequency, and patient preference to optimize outcomes related to morbidity, mortality, and quality of life 2.