Is it reasonable to switch Advair (fluticasone-salmeterol) to Symbicort (budesonide-formoterol) in a patient with uncontrolled asthma?

From the Guidelines

It is reasonable to switch from Advair to Symbicort in an uncontrolled asthmatic patient, as both medications are ICS/LABA combinations, but Symbicort's faster onset of action and potential for SMART therapy may offer better symptom control. Both Advair and Symbicort are used for long-term control and prevention of symptoms in moderate or severe persistent asthma, as stated in the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1. The EPR-3 guidelines recommend the use of ICSs as the most consistently effective long-term control medication at all steps of care for persistent asthma, and LABAs are preferred as adjunctive therapy to combine with ICSs in youths 12 years of age and adults.

When switching from Advair to Symbicort, it is essential to ensure equivalent dosing, such as switching from Advair 250/50 twice daily to Symbicort 160/4.5 two inhalations twice daily. Patients should be monitored closely for symptom control and potential side effects during the transition. Additionally, verifying proper inhaler technique with the new device is crucial, as Symbicort uses a different inhaler mechanism than Advair, which could affect medication delivery and efficacy.

Some key points to consider when making this switch include:

• Symbicort's formoterol has a faster onset of action compared to salmeterol in Advair, which may provide quicker relief for patients 1.
• Symbicort can be used as both maintenance and rescue therapy in some patients, known as SMART therapy, which may simplify treatment regimens and improve adherence.
• The EPR-3 guidelines emphasize the importance of individualizing treatment and adjusting therapy based on patient response, making a switch from Advair to Symbicort a reasonable consideration for uncontrolled asthmatic patients 1.

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Asthma Adult and Adolescent Subjects Aged 12 Years and Older In clinical trials comparing fluticasone propionate and salmeterol inhalation powder with its individual components, improvements in most efficacy endpoints were greater with fluticasone propionate and salmeterol inhalation powder than with the use of either fluticasone propionate or salmeterol alone

The provided text does not directly support the answer to whether it is reasonable to switch Advair to Symbicort in uncontrolled asthmatic patients. Key points:

• The label discusses the efficacy of fluticasone propionate and salmeterol inhalation powder compared to its individual components.
• It does not provide information on switching from Advair (fluticasone propionate and salmeterol) to Symbicort (budesonide and formoterol).
• No direct comparison or guidance on switching between these two combination inhalers is provided in the given text. 2

From the Research

Switching from Advair to Symbicort in Uncontrolled Asthmatic Patients

• The decision to switch from Advair (fluticasone/salmeterol) to Symbicort (budesonide/formoterol) in uncontrolled asthmatic patients can be considered based on several studies 3, 4, 5, 6, 7.
• A study published in 2007 compared budesonide/formoterol maintenance and reliever therapy with high-dose salmeterol/fluticasone in patients with uncontrolled asthma, and found that budesonide/formoterol reduced total exacerbations and exacerbations requiring hospitalization/emergency room treatment 5.
• Another study published in 2011 compared fixed-dose combination fluticasone and salmeterol with budesonide and formoterol in adults and children with chronic asthma, and found that the two treatments had similar effects on lung function, symptoms, and quality of life, but the odds of exacerbations requiring oral steroids were lower with fluticasone/salmeterol 7.
• A review of the literature suggests that both Advair and Symbicort are effective treatments for asthma, but the choice between them may depend on individual patient factors, such as the severity of their asthma, their response to treatment, and their preferences 4, 6.
• The study published in 2022 found that switching to a new device such as Spiromax can improve inhaler technique and clinical outcomes in patients with uncontrolled asthma, and that patient education and correct inhaler technique are key factors in the successful delivery of inhaled asthma therapy 3.

Key Considerations

• The effectiveness of switching from Advair to Symbicort may depend on individual patient factors, such as the severity of their asthma and their response to treatment.
• Patient education and correct inhaler technique are crucial for the successful delivery of inhaled asthma therapy.
• The choice between Advair and Symbicort should be based on a thorough assessment of the patient's needs and preferences, as well as the potential benefits and risks of each treatment option.