Can Symbicort and Advair Be Used Together?
No, a patient should not be on both Symbicort (budesonide/formoterol) and Advair (fluticasone/salmeterol) simultaneously, as this would result in dangerous duplication of both inhaled corticosteroids and long-acting beta-agonists without clinical benefit. 1
Why This Combination Is Inappropriate
Medication Overlap Creates Redundancy
- Both Symbicort and Advair are ICS/LABA combination products that serve the identical therapeutic purpose of providing maintenance anti-inflammatory control plus long-acting bronchodilation 1, 2
- Using both simultaneously doubles the exposure to two drug classes (inhaled corticosteroids AND long-acting beta-agonists) without evidence of additional benefit 1, 3
- This represents irrational polypharmacy that increases cost, side effect risk, and medication burden 3
Safety Concerns With Dual ICS/LABA Therapy
- The American College of Chest Physicians notes that multiple corticosteroid inhalers could potentially increase the risk of systemic corticosteroid effects, including adrenal suppression, bone density loss, and increased pneumonia risk in COPD patients 3
- Excessive LABA exposure from two combination inhalers has not been studied and may increase cardiovascular side effects (tachycardia, tremor, hypokalemia) 1
What To Do Instead
If Current Control Is Inadequate on One ICS/LABA
- Step up therapy by adding a third medication class rather than duplicating the same classes 1, 3
- For asthma: Add a long-acting muscarinic antagonist (LAMA) like tiotropium, or add a leukotriene modifier (montelukast), or consider biologics for severe disease 1, 4
- For COPD: Add tiotropium to create triple therapy (ICS/LABA/LAMA), which the American College of Chest Physicians supports for GOLD category D patients with frequent exacerbations 1, 3
If Switching Between Products
- Choose one combination product based on clinical needs 4, 5:
- Discontinue the previous ICS/LABA completely when initiating the new one 1
Common Pitfalls to Avoid
- Never use LABA monotherapy without an ICS, as the American Academy of Family Physicians warns this is associated with increased risk of asthma-related death and hospitalization 4
- Overreliance on rescue inhalers (using short-acting beta-agonists more than twice weekly) indicates inadequate maintenance therapy and requires step-up treatment, not duplication of current therapy 1, 3
- Failure to assess whether the patient actually needs combination therapy at all—some patients on ICS/LABA combinations may be adequately controlled by stepping down to ICS monotherapy 1