Advair Solution Availability
Advair (fluticasone propionate/salmeterol) is not available in a solution or nebulized formulation—it exists only as a dry powder inhaler (DPI) and metered-dose inhaler (MDI). 1
Available Formulations of Advair
- Dry Powder Inhaler (Diskus/Inhub): Contains fluticasone propionate (100,250, or 500 mcg) combined with salmeterol (50 mcg) as a powder formulation for oral inhalation 1
- Metered-Dose Inhaler (MDI): Available as an HFA-propelled aerosol formulation 2
- No nebulizer solution exists for this combination product 1
Alternative Options for Patients Unable to Use DPI
Individual Component Nebulization
- Budesonide nebulizer suspension is the only FDA-approved inhaled corticosteroid available as a nebulized solution for patients who cannot use inhalers 3
- Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 3
- Albuterol/salbutamol can be nebulized at doses of 2.5-5 mg for bronchodilation 3
Critical Limitation
- No long-acting beta-agonist (LABA) like salmeterol is available in nebulized form 3
- This means the specific combination of fluticasone/salmeterol cannot be replicated via nebulization 1
Delivery Device Alternatives for Advair
For Patients with Poor Inhaler Technique
Proper assessment is essential before changing devices:
- 76% of COPD patients make important errors when using MDIs, while only 10-40% make errors with DPIs depending on the device 3
- Inhaler technique must be demonstrated before prescribing and re-checked before modifying treatments 3, 4
If DPI cannot be used effectively:
- Advair HFA (MDI formulation) with a spacer device may be more appropriate 2
- Spacer devices significantly reduce technique errors and improve drug delivery 3
- Most patients can be successfully treated with MDIs plus spacers rather than requiring nebulizers 3
When Nebulizers Are Justified
Nebulizers should only be considered after:
- Confirming the diagnosis is correct 3
- Ensuring optimal use has been made of MDI and DPI devices with spacers 3
- Demonstrating that the patient responds to nebulized therapy 3
- Assessment by a respiratory physician who can advise on risk/cost benefit 3
Common Pitfall to Avoid
Do not assume nebulizers are automatically better for patients with poor technique. Most patients who struggle with inhalers can be successfully managed with proper training on MDI technique plus spacer devices, which is more cost-effective than nebulizer therapy 3. The usability studies demonstrate that the majority of patients, including those naive to DPIs, can safely and effectively use the Inhub/Diskus device with appropriate instruction 5.