Advair Diskus Dosage for Adults and Adolescents
For adults and adolescents with asthma, start with Advair Diskus 100/50 (fluticasone 100 mcg/salmeterol 50 mcg) one inhalation twice daily for mild to moderate disease, or 250/50 for moderate to severe asthma, with a maximum dose of 500/50 twice daily for severe disease. 1, 2
Standard Dosing by Asthma Severity
Mild to Moderate Asthma:
- Advair Diskus 100/50: One inhalation twice daily (12 hours apart) 2, 3
- This corresponds to fluticasone 100 mcg + salmeterol 50 mcg per inhalation 4, 5
Moderate to Severe Asthma:
- Advair Diskus 250/50: One inhalation twice daily 4, 5
- The 250/50 combination is more effective than fluticasone 500 mcg alone for moderate to severe asthma 2
Severe Asthma:
Dosing Algorithm Based on Current Treatment
If currently using only short-acting beta-agonists:
- Start with Advair 100/50 twice daily if using rescue inhalers ≥2-3 times daily 2
- This provides both controller and bronchodilator therapy in one device 4
If already on inhaled corticosteroids with poor control:
- Add salmeterol by switching to combination therapy rather than doubling the corticosteroid dose alone 2
- Advair 100/50 is superior to fluticasone 100 mcg alone for all efficacy outcomes 3
If on higher-dose inhaled corticosteroids:
- Switch to Advair 250/50 or 500/50 depending on previous corticosteroid dose 6
Fluticasone Dose Categories in Advair
The fluticasone component follows standard inhaled corticosteroid dosing categories 6, 2:
- Low dose: 88-264 mcg/day (Advair 100/50 twice daily = 200 mcg/day)
- Medium dose: >264-440 mcg/day (Advair 250/50 twice daily = 500 mcg/day)
- High dose: >440 mcg/day (Advair 500/50 twice daily = 1000 mcg/day)
Critical Safety Considerations
Never use long-acting beta-agonists as monotherapy:
- Long-acting beta-agonists should never be used alone for asthma control 6, 2
- They must always be combined with inhaled corticosteroids due to increased risk of severe exacerbations and deaths when used as monotherapy 6
- The fixed-combination inhaler ensures appropriate use of salmeterol with a corticosteroid 4
Administration Technique
Proper inhaler technique is essential:
- Exhale fully before placing mouthpiece between lips 1
- Inhale deeply and forcefully through the Diskus device 7
- Hold breath for 10 seconds if possible 1
- Rinse mouth and spit after each use to prevent oral candidiasis 6
Dose Titration Strategy
After achieving control (1-3 months of stability):
- Decrease by 25-50% at each step-down 2
- Consider stepping down to lower strength Advair or to inhaled corticosteroid alone 6
- Monitor closely for loss of asthma control during step-down 6
If inadequate control on current dose:
- Increase to next higher strength before increasing frequency 2
- Verify proper inhaler technique and adherence before escalating 6
Special Populations
Elderly patients:
- No dose adjustment required based on age alone 1, 2
- Monitor closely for tremor from salmeterol and systemic corticosteroid effects 1
- Consider ECG monitoring with first dose in patients with ischemic heart disease 1
- Assess ability to use Diskus device properly, as coordination may be impaired 1
Children 4-11 years:
- Advair Diskus 100/50 is approved for this age group 6
- Most children ≥4 years can generate sufficient inspiratory flow for Diskus device 6
Common Pitfalls to Avoid
- Using as rescue medication: Advair is for maintenance only, not for acute symptoms 4
- Discontinuing inhaled corticosteroids: Never switch to salmeterol monotherapy 6
- Poor inhaler technique: Verify technique at each visit, especially in elderly patients 1
- Not rinsing mouth: Increases risk of oral candidiasis and systemic absorption 6
- Expecting immediate relief: Onset of bronchodilation occurs within 30 minutes, but full anti-inflammatory effect takes days to weeks 4, 5
Monitoring for Adverse Effects
Common side effects to monitor: