What to Know About Advair Diskus (Fluticasone/Salmeterol)

This oral inhaler can be used to treat COPD symptoms

The human respiratory system.
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Advair Diskus is an inhaled prescription drug intended to be used regularly to treat some people with chronic obstructive pulmonary disease (COPD) and/or asthma. It contains a combination of two different drugs to help you breathe better: fluticasone propionate, a corticosteroid, and salmeterol, a long-lasting beta-agonist. Together, they improve symptoms by reducing inflammation and swelling, as well as relaxing and widening your airways.

Uses

Advair Diskus is intended to be a long-acting maintenance medication that prevents breathing difficulties from progressing for some people with COPD and/or asthma. According to the manufacturer, Advair is clinically proven to help improve your lung function, lessening your symptoms of wheezing, chest tightness and chronic cough.

This medication contains two drugs that make it easier for you to breathe. Each works in a unique way, and the combination of the two is more effective than each drug alone for some people:

  • Flovent (fluticasone propionate) is a glucocorticoid that improves your symptoms by reducing inflammation and swelling in your airways.
  • Serevent (salmeterol) is a long-acting beta agonist (a type of bronchodilator) that helps relax and widen your airways.

Advair Diskus is not intended as a short-acting rescue medication, as some inhaled medicines are. Taking extra doses of Advair in acute situations won't improve your breathing and, actually, could cause more harm.

Advair Diskus should not be used in children under the age of 4.

COPD With Asthma

While Advair may be used early on with asthma, it is not often used early on with COPD unless a person also has asthma and/or an elevated eosinophil count.

COPD Without Asthma

In people who have COPD but do not have asthma, glucocorticoids (such as fluticasone in Advair) are not recommended unless a person has one or more COPD exacerbations per year. If a person is using a glucocorticoid and has not had an exacerbation for one year, it's recommended that it be discontinued. In this case, the long-acting beta agonist component (salmeterol) alone may be continued.

For those who have COPD and experience either shortness of breath or exercise intolerance, 2020 guidelines recommend the use of a combination of two categories of bronchodilators. This includes a long-acting beta agonist (LABA) and a long-acting anticholinergic/muscarinic antagonist (LAMA) rather than either of these classes of medications alone. If exacerbations continue despite this combination, a glucocorticoid may then be considered.

If you have asthma or experience COPD exacerbations, be sure to have a separate rescue inhaler for acute attacks.

Before Taking

Your doctor will determine if you're a good candidate for Advair Diskus by looking at your health history. If you have COPD, your physician may assess the frequency and severity of past COPD exacerbations, your current lung function (often measured via spirometry), what other medications you're currently taking, and if you have any allergies or liver issues (hepatic impairment).

Wixela Inhub is an authorized generic form of Advair Diskus that contains the exact same drugs and dosages as the brand name formula. Ask your pharmacist about it if the cost is a hindering concern.

Precautions and Contraindications

If you have asthma, studies have shown that you have an increased risk of death from asthma complications when taking salmeterol. If you find you're having more trouble breathing after you start using Advair Diskus regularly, you should talk to your doctor immediately. They may need to change your medication.

People with severe milk protein allergy shouldn't use Advair, as the medication contains both lactose (milk sugar) and milk proteins. Inhaling something to which you're allergic can result in a severe reaction.

For those who have already been diagnosed with a bone health concern such as osteoporosis or osteopenia prior to taking Advair, know that long-term use of corticosteroids such as this one may cause further decreases in bone mineral density.

You you may be affected by any of these issues, ask your physician if you're a better candidate for another drug similar to Advair Diskus, such as:

  • AirDuo RespiClick (fluticasone and salmeterol)
  • Serevent Diskus (salmeterol)
  • Breo Ellipta (fluticasone furoate and vilanterol)
  • Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol)
  • Symbicort (formoterol and budesonide)
  • Spiriva (tiotropium)
  • Pulmicort (budesonide)

Dosage

Advair Diskus is a dry powder inhaler. Generally, you'll need to use it twice a day for it to be effective. Each inhaler comes with 60 doses equaling a one-month supply.

Available dosages include 100/50, 250/50, and 500/50, and the starting dose your doctor recommends will be based on the severity of your condition.

According to the manufacturer:

  • For a child with asthma between the ages of 4 and 11: One inhalation of Advair Diskus 100/50 twice daily (every 12 hours). 
  • For a person with asthma age 12 or older: One inhalation of Advair Diskus 100/50, 250/50, or 500/50 twice daily (every 12 hours).
  • For a person with COPD: One inhalation of Advair Diskus 250/50 twice daily (every 12 hours).

Never take more than is prescribed.

How to Take and Store

To take Advair Diskus, you'll first need to remove the device from its foil packaging.

The device should be in its closed position. You'll see a dosage counter on the top that tells you how many doses you have left.

To prepare your dose:

  1. Push the thumb grip and slide the device into its open position, revealing the inhaler mouthpiece.
  2. Holding the Diskus level and flat (parallel to the ground), slide the lever until you hear it click.

To take your dose:

  • Without putting the inhaler to your mouth just yet, exhale as much as you can.
  • With your next inhalation, bring the device up to your mouth and breathe in quickly and deeply through the Diskus. Keep it level and be sure not to inhale through your nose.
  • Remove Advair Diskus from your mouth and hold your breath for 10 seconds.
  • Slowly exhale, then use the thumb grip to close the device.
  • Rinse your mouth with water (do not swallow).

See the instructions provided by the manufacturer for more information.

Because the dry powder is so fine, you may not feel the medication in your mouth when you inhale. Don't worry—as long as you checked that the inhaler was not empty beforehand, it's there. Do not take an extra dose even if you don't taste or feel the medicine.

The inhaler is not refillable or reusable and should be discarded one month after opening. Write the date of opening in the space provided on the front of the inhaler.

Be sure to store your Advair Diskus inhaler away from sunlight and heat, and keep it out of reach of children.

Side Effects

People who use Advair Diskus are at risk of developing several side effects. Some are relatively minor, such as throat scratchiness, and others are more severe, such as osteopenia.

Common

Common side effects include:

  • Throat irritation
  • Hoarseness
  • Voice changes
  • Diarrhea
  • Headaches
  • Bone and muscle pain

Talk to your doctor if these side effects become troublesome.

In addition, you may develop thrush, a yeast infection in your mouth and/or throat. Thrush causes a white or yellowish coating, so you may see it if it develops. While rinsing your mouth out after using your inhaler can help prevent this, even diligent rinsing doesn't always do so. If thrush occurs, your doctor can prescribe a mouthwash that should resolve the issue.

Severe

People using Advair may develop a weakened immune system and an increased risk of infection. That's because corticosteroids (one of the two active ingredients in the medication) tend to suppress your immune system. To stay well, do all you can to avoid being exposed to flu or illness, as taking Advair can make you more susceptible to infection.

When taking corticosteroids, common infections such as chickenpox and measles can be much more serious and even fatal in children and adults who contract these diseases. If you know you've been exposed, you should contact your doctor as soon as you can. If you have an existing infection, such as tuberculosis, you may find it gets worse.

Advair also may raise your risk of pneumonia, which is already elevated if you have COPD. This increased risk of pneumonia is why Advair is not recommended unless you also have asthma, a high eosinophil count, or experience more than one COPD exacerbation yearly. If you develop pneumonia symptoms, which include increased mucus, fever, chills, or worsening breathing problems, call your doctor immediately.

While the risk of weakened bones is of particular concern for those diagnosed with a bone disease before taking Advair, the potential for this should be considered by all users.

Finally, regular eye exams are recommended while you're using Advair since the medication raises your risk of glaucoma and cataracts.

Warnings and Interactions

Advair Diskus does come with a black box warning regarding the risks of salmeterol. Advair Diskus should only be used in asthma patients if their condition is not adequately controlled by another medication.

If you are taking Advair and you find your breathing problems worsening quickly (and if your rescue inhaler doesn't help), you should go to the emergency room immediately. Make sure to tell the clinicians there which drugs you're taking, be them over-the-counter or prescription.

Taking more Advair than prescribed won't help your breathing, and overdosing on the medication could lead to serious symptoms such as shakiness, chest pain, fast or irregular heartbeat, weakness, headaches, nausea and vomiting, and even seizures.

Some people develop negative symptoms such as irregular heartbeat, shakiness, and weakness even when they're taking the correct dosage of their medication. If this happens to you, contact your doctor immediately or go to the emergency room.

In addition, you shouldn't take other similar drugs while taking Advair, as taking more than one long-acting beta-agonist could cause severe side effects. Make sure to tell your doctor about anything you take, even over-the-counter drugs or supplements, to avoid problems with drug interactions.

A Word From Verywell

It's important to know that Advair Diskus is not a rescue inhaler and should only be used as a long-acting medication. It may be best used in those with COPD as opposed to asthma, given the risk of asthma-related deaths associated with salmeterol. As with any medication, Advair Diskus should also only be taken as prescribed to minimize side effects.

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Article Sources
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  1. MedlinePlus. Fluticasone and salmeterol oral inhalation. Updated April 15, 2019.

  2. Advair. About Advair.

  3. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2020. 201(9). doi:10.1164/rccm.202003-0625ST

  4. U.S. Food and Drug Administration. Advair Diskus prescribing information.

  5. ADVAIR. How to use ADVAIR DISKUS.

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