What is the role of Advair (fluticasone-salmeterol) in Chronic Obstructive Pulmonary Disease (COPD) management?

From the Guidelines

Advair is recommended for patients with moderate to severe COPD who experience frequent exacerbations, as it reduces symptoms, improves lung function, and decreases the frequency and severity of exacerbations, as shown in the 2023 Canadian Thoracic Society guideline 1.

Key Points

• Advair contains two active ingredients: fluticasone (a corticosteroid) and salmeterol (a long-acting bronchodilator)
• It is typically prescribed as Advair Diskus 250/50 or 500/50, taken twice daily with approximately 12 hours between doses
• The medication helps reduce COPD symptoms like shortness of breath, wheezing, and coughing while decreasing the frequency and severity of exacerbations
• Patients should rinse their mouth after using Advair to prevent thrush (oral fungal infection)
• Advair works best as part of a comprehensive COPD management plan that may include other medications, pulmonary rehabilitation, and lifestyle modifications

Benefits of Advair

• Reduces symptoms and improves lung function in patients with moderate to severe COPD
• Decreases the frequency and severity of exacerbations
• Improves health-related quality of life
• Reduces hospitalizations due to exacerbations

Important Considerations

• The 2023 Canadian Thoracic Society guideline recommends the use of Advair in patients with moderate to severe COPD who experience frequent exacerbations 1
• The guideline also recommends the use of triple therapy (LABA/LAMA/ICS) in patients with severe COPD and a history of frequent exacerbations
• The choice of inhaler device should be a shared provider-patient decision, taking into account factors such as patient inhaler technique, preference, cost/insurance coverage, and clinical course, as well as the environmental impact of the device 1

From the FDA Drug Label

The efficacy of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg and fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg in the treatment of subjects with COPD was evaluated in 6 randomized, double-blind, parallel-group clinical trials in adult subjects aged 40 years and older Improvements in lung function (as defined by predose and postdose FEV1) were significantly greater with fluticasone propionate and salmeterol inhalation powder than with fluticasone propionate, salmeterol, or placebo Subjects receiving fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg had significantly greater improvements in predose FEV1 at Endpoint (165 mL, 17%) compared with salmeterol 50 mcg (91 mL, 9%) and placebo (1 mL, 1%) The primary endpoint was the comparison of pre-bronchodilator FEV1 in the groups receiving fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg or placebo Subjects treated with fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg had greater improvements in FEV1 (113 mL, 10%) compared with fluticasone propionate 500 mcg (7 mL, 2%), salmeterol (15 mL, 2%), and placebo (-60 mL, -3%)

Advair is effective in treating COPD. The drug label shows that fluticasone propionate and salmeterol inhalation powder (Advair) improves lung function and reduces exacerbations in subjects with COPD. Key points include:

• Significant improvements in lung function (FEV1) compared to placebo and individual components
• Reduction in COPD exacerbations
• Effective in subjects with a history of COPD and exacerbations 2

From the Research

Advair for COPD Treatment

• Advair, a combination of fluticasone and salmeterol, is a commonly prescribed medication for the treatment of chronic obstructive pulmonary disease (COPD) 3.
• According to a systematic review and network meta-analysis, fluticasone/salmeterol was found to be effective in reducing mortality and moderate-to-severe exacerbations in patients with COPD 4.
• The American Thoracic Society recommends the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance 5.
• A study on the efficacy of tiotropium-olodaterol fixed-dose combination in COPD found that it improved spirometric values, dyspnea, and health-related quality of life compared to placebo 6.
• Another study compared the efficacy of different combination bronchodilators, including LABA/LAMA fixed-dose combinations, and found that they offered superior benefits in terms of lung function and patient-reported outcomes compared to monocomponent therapies 7.

Efficacy and Safety of Advair

• The network meta-analysis found that fluticasone/salmeterol was associated with an increased risk of pneumonia, but was also effective in reducing mortality and exacerbations 4.
• The study on tiotropium-olodaterol found that it was well-tolerated and had a favorable safety profile 6.
• The American Thoracic Society recommends careful consideration of the potential benefits and harms of inhaled corticosteroids (ICS) in patients with COPD, including the risk of pneumonia 5.
• A review of the role of ICS/LABA fixed-dose combinations in the treatment of asthma and COPD found that they are effective and well-tolerated, but may be associated with an increased risk of pneumonia 3.

Comparison with Other Treatments

• The network meta-analysis found that tiotropium/budesonide/formoterol was the most effective treatment in reducing moderate-to-severe exacerbations, while fluticasone/salmeterol was more effective in reducing mortality 4.
• The study on tiotropium-olodaterol found that it was more effective than salmeterol-fluticasone in improving pulmonary function 6.
• The review of combination bronchodilators found that LABA/LAMA fixed-dose combinations offered superior benefits in terms of lung function and patient-reported outcomes compared to monocomponent therapies 7.