Advair: Combination treatment with fluticasone propionate/salmeterol in the treatment of asthma

Several classes of medications are available for the treatment of asthma, a nd often they must be taken concurrently to achieve asthma control. Based o n the understanding of asthma as an inflammatory disease, the National Hear t Lung and Blood Institute guidelines provide a stepwise approach to pharma cologic therapy. Corticosteroid therapy, principally inhaled corticosteroid (ICS) therapy, is considered the most effective antiinflammatory treatment . In cases of moderate-to-severe persistent asthma, the addition of a secon d long-term control medication to ICS therapy is one recommended treatment option. A combination-product inhaler (Advair, Seretide) was developed to t reat both the inflammatory and bronchoconstrictive components of asthma by delivering a dose of the ICS, fluticasone propionate, and a dose of the lon g-acting beta (2)-adrenergic (LABA) bronchodilator, salmeterol. The Advair Diskus is available in 3 strengths of fluticasone propionate (100, 250, and 500 mug) and a fixed dose (50 mug) of salmeterol, Combination treatment wi th both ICS and LABA provides greater asthma control than increasing the IC S dose alone, while at the same time reducing the frequency and perhaps the severity of exacerbations. Furthermore, salmeterol added to ICS therapy pr ovides superior asthma control compared with the addition of leukotriene mo difiers or theophylline. The superior control is likely a consequence of th e complementary actions of the drugs when taken together, including the act ivation of the glucocorticoid receptor by salmeterol, By combining anti-inf lammatory treatment with a long-acting beta (2)-agonist in a single inhaler (1 inhalation twice daily), physicians can provide coverage for both the i nflammatory and bronchoconstrictive aspects of asthma without introducing a ny new or unexpected adverse consequences, The most common drug-related adv erse events were those known to be attributable to the constituent medicati ons (ICS therapy and/or LABA therapy). Although the benefits of combined IC S plus LABA therapy can be achieved with separate inhalers, the convenience of the combination product may improve patient adherence and may therefore reduce the morbidity of asthma.