Advair Inhaler (fluticasone, salmeterol) is used to help manage symptoms of asthma or chronic obstructive pulmonary disease (COPD). In both cases the medication should reduce the frequency of attacks and, when they do happen, they should be less severe.

Advair Inhaler is a maintenance inhaler, meaning it should be taken every day regardless of the presence or absence of symptoms; little benefit is to be had if used only sporadically. It is not a rescue inhaler; a fast-acting rescue treatment, such as albuterol, should always be kept on hand for emergencies.

Inhaler versus Diskus

Note that this product is the inhaler; it is distinct from the Advair Diskus. While both contain the same active ingredients, there are some important differences:

• The inhaler delivers aerosol propelled by HFA to administer the medication to the lungs; it relies much less on breathing technique. Some individuals do not react well to HFA.
• The diskus delivers a fine powder and is largely dependent on the patient's ability to breathe it in to disperse it in the lungs. The diskus contains milk proteins, which some patients are allergic to.
• The diskus can be used in patients age 4 and up; the inhaler ages 12 and up.

Both the inhaler and diskus are available in a range of strengths; double-check the prescribed strength is chosen before purchasing.

Other Concerns

Advair Inhaler and Diskus both contain two active ingredients:

• Fluticasone is a corticosteroid that inhibits immune response to allergens and irritants, thus reducing the inflammation that leads to restricted airways.
• Salmeterol is a long-acting beta2-adrenergic receptor agonist (LABA) bronchodilator that relaxes and widens the airways, reducing symptoms of an attack.

Used together---and used as directed---these two ingredients can make a tremendous positive difference for patients. However, the use of Salmeterol---like all LABAs---is a little controversial.

Research suggests that individuals who take a LABA are at increased risk of asthma-related death, as the medication can cause increased bronchial sensitivity and inflammation with very little warning. While some studies suggest this risk is eliminated when a LABA is taken with a corticosteroid like fluticasone, others suggest the risk is not mitigated at all.

Risk of death from asthma or COPD is already very small, and the increased risk of LABA use is likewise very small. Patients with very severe asthma or COPD may want to use caution, and take care to avoid using other LABAs without explicit doctor approval. Patients also may want to avoid using LABAs without a corticosteroid.

Other than salmeterol, other common LABAs are formoterol and bambuterol. Albuterol is a short-acting beta2-adrenergic receptor agonist, not long-acting, and so is not a LABA.

Using Advair Inhaler

Advair Inhaler comes in a metered-dose inhaler, which can be used with or without a spacer. The inhaler should be shaken before each use, and should be primed before first use. To prime, simply actuate the inhaler 4 times before first use.

Use is easy; patients age 12 and up should:

• Administer 2 inhalations twice per day, for a total of 4 inhalations.
• Exhale fully before administering an inhalation; breathe in fully and deeply with each inhalation.
• Wait at least one minute before administering the second inhalation.
• Rinse mouth with water when finished.

Patients should not use more than 4 total daily inhalations. If the medication is not providing sufficient benefit, increasing dosage will be far more beneficial than increasing number of inhalations.

Some patients notice improvements after the first dose, but most will need to wait around one week before significant improvement is seen.

A doctor may advise some patients with mild asthma or COPD to use just 1 inhalation twice per day; this is relatively normal.

Inhalers should not be exposed to extreme heat or cold; this can interfere with its effectiveness. Exposure to extreme heat may cause the canister to explode.