What are the alternatives to Flovent (fluticasone) for asthma treatment?

Alternatives to Flovent (Fluticasone) for Asthma Treatment

The most effective alternatives to Flovent (fluticasone propionate) for asthma treatment include other inhaled corticosteroids like budesonide, leukotriene receptor antagonists like montelukast, or combination therapies depending on asthma severity and control. 1

Alternative Inhaled Corticosteroids

• Other inhaled corticosteroids (ICSs) can be used as alternatives to fluticasone propionate, as they all work by reducing airway inflammation, inhibiting inflammatory cell migration, and blocking late-phase allergic reactions 1
• Available alternative ICS options include:
  • Budesonide (Pulmicort) - administered twice daily 2
  • Beclomethasone dipropionate (QVAR) - administered twice daily 1
  • Mometasone furoate (Asmanex) - can be administered once daily 2
  • Ciclesonide (Alvesco) - can be administered once daily 2

Non-Corticosteroid Alternatives

• Leukotriene receptor antagonists (LTRAs) are appropriate alternative therapies for mild persistent asthma in patients unable or unwilling to use inhaled corticosteroids 1

  • Montelukast (Singulair) - administered once daily, approved for patients older than one year 1
  • Zafirlukast (Accolate) - administered twice daily, approved for patients seven years and older 1
  • LTRAs have advantages of ease of use and high compliance rates 1

• Cromolyn sodium and nedocromil are alternative (though not preferred) medications for mild persistent asthma that work by stabilizing mast cells 1

  • Can also be used as preventive treatment before exercise or unavoidable allergen exposure 1

• Methylxanthines such as sustained-release theophylline can be used as alternative therapy for mild persistent asthma, though monitoring of serum theophylline concentration is essential 1

Combination Therapies

• For moderate to severe persistent asthma, combination therapies may be more effective than increasing ICS dose alone 3:
  • Fluticasone/salmeterol (Advair) - combines an ICS with a long-acting beta-agonist (LABA) 4
  • Budesonide/formoterol (Symbicort) - another ICS/LABA combination 5
  • Fluticasone furoate/vilanterol (Breo) - a once-daily ICS/LABA combination 6

Stepwise Approach Based on Asthma Severity

• Step 1 (Intermittent asthma): Short-acting beta-agonist as needed 1
• Step 2 (Mild persistent asthma):
  • Preferred: Low-dose ICS
  • Alternative: LTRA, cromolyn, nedocromil, or theophylline 1
• Step 3 (Moderate persistent asthma):
  • Preferred: Low-dose ICS plus LABA or medium-dose ICS
  • Alternative: Low-dose ICS plus LTRA, theophylline, or zileuton 1
• Step 4 (Moderate-to-severe persistent asthma):
  • Preferred: Medium-dose ICS plus LABA
  • Alternative: Medium-dose ICS plus LTRA, theophylline, or zileuton 1
• Step 5-6 (Severe persistent asthma):
  • High-dose ICS plus LABA, with consideration of omalizumab for allergic asthma 1

Clinical Considerations and Caveats

• A randomized controlled trial showed that in children with mild persistent asthma well-controlled on fluticasone, switching to montelukast resulted in similar patient-oriented outcomes with fewer respiratory infections compared to continuing fluticasone or using fluticasone/salmeterol 1

• LABAs should never be used as monotherapy for asthma control; they must always be used in combination with an ICS due to safety concerns 1

• When choosing an alternative to fluticasone, consider:

  • Patient age (some medications have age restrictions)
  • Ease of use and adherence potential
  • Delivery device options (MDI, DPI, nebulizer)
  • Dosing frequency preferences (once vs. twice daily)
  • Side effect profiles 1, 2

• For patients using MDI devices, using a spacer and rinsing the mouth after use can reduce local side effects 2