Can Flonase and Advair Be Prescribed Together?
Yes, a healthcare provider can and often should prescribe Flonase (fluticasone nasal spray) and Advair (fluticasone/salmeterol inhaler) together for patients with both asthma and allergic rhinitis, as these medications target different anatomical sites and treating both conditions improves overall outcomes.
Rationale for Combined Therapy
Patients with asthma frequently have concomitant allergic rhinitis, and treating both conditions simultaneously improves asthma control and quality of life. 1
In patients with pollen-induced rhinitis and asthma, the combination of intranasal and inhaled glucocorticosteroids (both fluticasone formulations) is needed to control the seasonal increase in both nasal and asthmatic symptoms. 1
The addition of fluticasone propionate aqueous nasal spray to patients already receiving fluticasone propionate/salmeterol (Advair) for asthma has been studied and demonstrates safety when used together. 1
Key Clinical Considerations
Different Sites of Action
Flonase delivers topical corticosteroid directly to nasal mucosa for rhinitis symptoms, while Advair delivers corticosteroid plus long-acting bronchodilator to lower airways for asthma control. 2, 3
These are distinct therapeutic targets with minimal overlap in local drug delivery, making combination therapy both logical and evidence-based. 1
Systemic Corticosteroid Exposure
While both medications contain fluticasone, the systemic absorption from properly used intranasal and inhaled formulations remains low and clinically acceptable for concurrent use. 2, 3
Monitor for potential cumulative corticosteroid effects (growth suppression in children, adrenal suppression, bone density changes) when using multiple corticosteroid-containing products, though this risk is generally low with recommended dosing. 2, 3
Evidence-Based Treatment Approach
For Moderate-Severe Persistent Asthma with Allergic Rhinitis
Prescribe Advair (fluticasone/salmeterol) for asthma control at appropriate step-based dosing (Step 3-4 therapy). 4, 5
Add Flonase (fluticasone nasal spray) for persistent nasal symptoms that impact quality of life or asthma control. 1
This combination provides superior symptom control compared to treating either condition alone. 1
Alternative Consideration
For patients requiring both medications, consider whether budesonide/formoterol (Symbicort) might be preferable to Advair, as it offers SMART protocol capability (maintenance and reliever therapy) for patients ≥12 years. 4, 6
If switching to Symbicort, you can still combine with Flonase nasal spray using the same rationale. 4
Critical Pitfalls to Avoid
Never use Advair's LABA component (salmeterol) as monotherapy—it must always be combined with inhaled corticosteroid due to increased risk of severe exacerbations and death. 4, 6
Do not assume that treating rhinitis alone will adequately control asthma—both conditions require targeted therapy. 1
Monitor rescue inhaler use: more than 2 days per week indicates inadequate asthma control and necessitates treatment escalation, regardless of rhinitis control. 4
Ensure proper inhaler technique for Advair and proper nasal spray technique for Flonase to maximize local delivery and minimize systemic absorption. 2, 3