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The combination preparation fluticasone/salmeterol is a formulation containing fluticasone propionate and salmeterol xinafoate used in the management of asthma and chronic obstructive pulmonary disease (COPD). It is marketed by GlaxoSmithKline under various trade names including Advair and Seretide.
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Formulations
Advair is available in 3 dosage strengths. The smallest dosage is 100/50, the intermediate dosage is 250/50 and the highest dosage is 500/50. The first number in the dosage description is how many micrograms of fluticasone propionate and the second number how many micrograms of salmeterol.
Internationally the fluticasone/salmeterol combination is delivered by a number of devices, including standard aerosol metered dose inhalers (brand name "Evohaler®" in the UK) or dry-powder devices termed "Accuhaler" in the UK and Australia, and "Diskus" in the U.S. These purple disk-shaped containers are about 3.5 inches (8.9 cm) across and about 1 inch thick (2.5 cm). The diskus container holds small pellets of the drug combination, which are crushed on a dose-per-dose basis into a fine powder utilizing an internal mechanism activated by pressing a small lever on the side of the container. The powder is then inhaled directly into the lungs through a mouthpiece. Fluticasone/salmeterol is usually inhaled two times a day.
Fluticasone, a corticosteriod, is the anti-inflammatory component of the combination, while salmeterol treats constriction of the airways. Together, they relieve the symptoms of coughing, wheezing and shortness of breath better than either fluticasone or someterol taken on its own.
Side effects
The common and minor side effects of this combination are those of its individual drugs. For instance, the use of inhaled corticosteroids is associated with oral candidiasis.
Whilst the use of inhaled steroids and long acting beta-adrenoceptor agonist (LABA) are recommended in asthma guidelines for the resulting improved symptom control,[1] concerns have been raised that salmeterol may increase the small risks of asthma deaths and this additional risk is not reduced with the additional use of inhaled steroids.[2] This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning.[3]
In a clinical trial, thirteen people died out of a group of 13,176 people taking ADVAIR.
Other side effects include increased blood pressure, change in heart rate, or an irregular heartbeat.
Footnotes
- ^ British Thoracic Society & Scottish Intercollegiate Guidelines Network (SIGN). British Guideline on the Management of Asthma. Guideline No. 63. Edinburgh:SIGN; 2004. (HTML, Full PDF, Summary PDF)
- ^ Salpeter S, Buckley N, Ormiston T, Salpeter E (2006). "Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths.". Ann Intern Med 144 (12): 904-12. PMID 16754916.
- ^ Krishna Ramanujan. "Common asthma inhalers cause up to 80 percent of asthma-related deaths, Cornell and Stanford researchers assert", ChronicalOnline - Cornell University.
