What is the proper usage and patient education for a 13-year-old patient using Advair (fluticasone and salmeterol) for asthma management?

Patient Education for Advair Use in a 13-Year-Old

For a 13-year-old with asthma, Advair (fluticasone/salmeterol combination) should be used as twice-daily maintenance therapy—not as a rescue inhaler—with proper inhaler technique, mouth rinsing after each use, and clear understanding that this medication prevents asthma symptoms rather than treating acute attacks. 1, 2

Understanding What Advair Does

Advair contains two medications that work differently:

• Fluticasone (the "preventer"): An inhaled corticosteroid that reduces airway inflammation over time 1, 3
• Salmeterol (the long-acting bronchodilator): Opens airways for 12 hours but does NOT work for sudden symptoms 1, 3

The combination provides superior asthma control compared to inhaled corticosteroids alone, addressing both the inflammatory and bronchoconstrictive components of asthma. 4, 5, 3

Critical Safety Points

Never use Advair as a rescue inhaler for acute symptoms. 1, 6 The patient must have a separate short-acting beta-agonist (like albuterol) for quick relief of sudden breathing problems. 6

Long-acting beta-agonists like salmeterol should never be used without an inhaled corticosteroid due to increased risk of asthma-related deaths when used as monotherapy. 6 The combination product ensures appropriate use.

Proper Administration Technique

Dosing schedule:

• Take exactly twice daily (morning and evening), approximately 12 hours apart 1, 2, 4
• Use every day even when feeling well—this is maintenance therapy, not as-needed medication 1, 3

Inhaler technique (Diskus dry powder inhaler):

• Hold the Diskus level and slide the lever until it clicks 2
• Breathe out fully away from the device 2
• Place mouthpiece in mouth and inhale deeply and forcefully 2
• Hold breath for 10 seconds if possible 2

After each use:

• Rinse mouth thoroughly with water and spit it out to prevent oral thrush (yeast infection in the mouth) and hoarseness 1, 2
• Do not swallow the rinse water 2

What to Monitor and Report

Common side effects to watch for:

• Oral thrush (white patches in mouth or throat) 1, 2
• Hoarseness or voice changes 1, 2
• Cough 1
• Headache 1
• Throat irritation 1

Seek medical attention immediately if:

• Asthma symptoms worsen despite using Advair 1
• Rescue inhaler is needed more frequently than usual 1
• Peak flow measurements drop below 60% of personal best 1
• Nighttime awakening due to asthma increases 1
• Any signs of allergic reaction occur 7

Growth Monitoring Considerations

At age 13, growth should be monitored periodically. 1 While inhaled corticosteroids at moderate doses may cause transient growth suppression (approximately 1 cm), this is generally non-progressive and asthma itself can delay growth more significantly. 1, 2 The benefits of asthma control typically outweigh this risk. 1

When Advair May Not Be Working

If asthma remains uncontrolled after 4-6 weeks of proper use:

• Verify inhaler technique is correct 1
• Confirm medication is being taken twice daily as prescribed 1
• Discuss with physician whether dose adjustment or alternative therapies are needed 6

Signs of inadequate control include:

• Symptoms persisting during the day 1
• Waking at night due to asthma 1
• Missing school due to asthma 1
• Limitations on physical activities or sports 1
• Using rescue inhaler more than twice weekly (excluding pre-exercise use) 1

Important Medication Interactions

Inform the physician about all medications, particularly strong CYP3A4 inhibitors like ketoconazole, which can significantly increase fluticasone exposure and systemic effects. 7

Self-Management Principles

The patient and family should understand:

• The difference between "preventer" (Advair) and "reliever" (albuterol) medications 1
• How to recognize worsening asthma symptoms 1
• When to seek urgent medical attention 1
• The importance of continuing Advair even when feeling well 1, 3

Peak flow monitoring (if prescribed):

• Measure morning peak flow before taking Advair 1
• Record measurements to track asthma control 1
• Know personal best and action thresholds 1

Storage and Handling

Store the Diskus in a dry place at room temperature. 7 The dose counter shows how many doses remain—obtain a refill when the counter shows "5" to avoid running out. 2