Should I stop taking Advair (fluticasone and salmeterol) and albuterol?

Should You Discontinue Advair and Albuterol?

No, you should not discontinue Advair (fluticasone and salmeterol) and albuterol without consulting your healthcare provider, as abrupt discontinuation of these medications can lead to worsening asthma symptoms and potentially dangerous exacerbations. 1

Understanding Your Medications

• Advair contains two components: fluticasone (an inhaled corticosteroid) that treats inflammation and salmeterol (a long-acting beta-agonist) that provides bronchodilation 2
• Albuterol is a short-acting beta-agonist (SABA) that provides rapid relief of acute bronchospasm 1
• These medications work together to control different aspects of asthma pathophysiology - inflammation, bronchoconstriction, and mucous plugging 1

Risks of Discontinuation

• Stopping inhaled corticosteroids can lead to increased airway inflammation and loss of asthma control 1
• Discontinuing salmeterol (the long-acting component of Advair) can result in loss of bronchodilation and worsening symptoms 1
• Albuterol is essential for quick relief of acute symptoms and should be available for rescue use 1

Specific Guidance for Medication Discontinuation

When Medications Should Be Temporarily Stopped

There are specific circumstances when these medications might need to be temporarily discontinued:

• For oral food challenges (OFC), short-acting bronchodilators like albuterol should be discontinued 8 hours before the test 1
• Long-acting bronchodilators like salmeterol (in Advair) should be discontinued 24 hours before an OFC 1
• For other diagnostic procedures, temporary discontinuation may be necessary under medical supervision 1

When Medications Should NOT Be Discontinued

• During periods of asthma exacerbation or increased symptoms 1
• Without a step-down plan supervised by your healthcare provider 1
• If you have moderate to severe persistent asthma requiring controller therapy 1, 3

Appropriate Medication Management

Step-Down Approach (If Appropriate)

If your asthma is well-controlled for at least 3 months, your provider might consider:

• Gradually reducing the dose of Advair rather than stopping it completely 1, 3
• Maintaining the lowest effective dose to control symptoms 1
• Continuing to have albuterol available for rescue use even if asthma is well-controlled 1

Monitoring for Asthma Control

Signs that your current medication regimen is appropriate and should not be discontinued:

• Minimal daytime symptoms (≤2 days/week) 1
• No nighttime awakenings due to asthma 1
• Minimal need for rescue albuterol (≤2 days/week) 1
• No limitation of normal activities 1

Common Pitfalls to Avoid

• Self-discontinuation: Never stop asthma medications without medical guidance 1
• Relying solely on albuterol: Using only rescue medication without controller therapy (like Advair) for persistent asthma leads to poor outcomes 1
• Misinterpreting symptom improvement: Feeling better on medication is a sign of effectiveness, not a reason to stop 1
• Concerns about side effects: The benefits of properly prescribed asthma medications typically outweigh the risks 1

When to Consult Your Healthcare Provider

• If you're experiencing side effects from your medications 1
• If you feel your asthma is well-controlled and want to discuss step-down therapy 1, 3
• If you're using albuterol more than twice weekly for symptom control (not including prevention of exercise-induced symptoms) 1
• If you have concerns about the cost or convenience of your current regimen 4, 5

Remember that asthma is a chronic condition requiring ongoing management, and maintaining proper controller therapy is essential for preventing exacerbations and maintaining lung function 1.