The Allergy Clinic
Specialists in Allergy & Asthma Care
Specialists in Allergy & Asthma Care
Is Advair Safe to Use?
UPDATED JANUARY, 2006
Advair has a black box warning and an editorial in a recent New England Journal of Medicine by Fernando D. Martinez, M.D., that says
other drugs should be used first (and second). This continues to cause concern in our patients with asthma who benefit from using
Advair.
However, it is still the belief of the doctors of The Allergy Clinic that Advair is safe when used as recommended. The Journal of Allergy
& Clinical Immunology has an editorial by Harold Nelson, MD, the most respected allergist in the country in its December, 2005 issue.
In it, Dr. Nelson defends Advair, stating that "these outcomes (deaths) were not a direct toxic effect of the drugs and increases the
possibility that they resulted from an interaction between relief of symptoms by β2-agonists and delay in seeking medical care."
In other words, it was not the combination drug, Advair, increasing the risk of death. Rather, it was use of Advair's component half,
Serevent, without also using an inhaled steroid. Plus, because stimulant drugs like Serevent and albuterol make your asthma feel better
for a little while, you may postpone the necessary doctor visit to get appropriate treatment.
July, 2005
An advisory panel of the FDA met this month to consider taking Advair off of the market. You can imagine the scare this put into our
patients who are taking that medication, particularly those who are receiving such benefit from it. Bottom line: If you are on Advair, Do
Not Worry! Do Not Stop the drug unless your doctor advises it. The FDA advisory panel unanimously decided not to remove Advair,
Serevent or Foradil from the market.
A little background on this…Advair is actually a combination of two drugs: salmeterol and fluticasone. Each of these was sold alone as,
respectively, Serevent and Flovent. Flovent is an inhaled steroid, and no one is worried about that drug. Serevent, on the other hand, is
a mixed blessing, particularly if it is being used by itself. Serevent is a bronchodilator, similar to albuterol (Ventolin, Proventil). Serevent
has a longer duration of action than albuterol, though. It works for 12 hours instead of 3 or 4 hours. The way that bronchodilators work is
by relaxing the smooth muscle on the outside of the airway. That relaxation allows the airway to open wider and let more air come
through. The relaxation actually takes place because albuterol and salmeterol are “beta agonists” and they stimulate “beta receptors”.
The problem with salmeterol by itself is that when you over-stimulate a beta receptor, your body responds by down-regulating
(decreasing) the production of the beta receptors. Thus, you end up with fewer receptors for those beta agonists to attach themselves to.
Luckily, that problem doesn’t happen when you use an inhaled steroid at the same time you use salmeterol. Advair contains salmeterol
and fluticasone, an inhaled steroid. One important benefit of inhaled steroids is that they up-regulate (increase) the production of beta
receptors. That up-regulation more than offsets the detrimental down-regulation that salmeterol by itself can cause.
Whenever The Allergy Clinic prescribes a long-acting beta agonist such as salmeterol (Serevent) or formoterol (Foradil), we also
prescribe an inhaled steroid to prevent any possible worsening of asthma symptoms. Advair has that beneficial inhaled steroid built in,
so there is usually no need to worry about Advair worsening your asthma.
In summary, Advair has been a wonderful addition in the treatment of asthma. Patients on it should continue using it, but please contact
your medical provider if you have questions. Patients on Serevent or Foradil who are not also using an inhaled steroid should contact
their medical provider as soon as possible to have their condition re-assessed.
DISCLAIMER: The Allergy Clinic offers information of a general nature about the conditions requiring the services of an allergist.
The information is provided with the understanding that The Allergy Clinic is not engaged in rendering surgical or medical advice or
recommendations. Any information in the publications, messages, postings, or articles should not be considered a substitute for
consultation with a board certified allergist to address individual medical needs. Individual facts and circumstances will determine
the treatment that is most appropriate.
UPDATED JANUARY, 2006
Advair has a black box warning and an editorial in a recent New England Journal of Medicine by Fernando D. Martinez, M.D., that says
other drugs should be used first (and second). This continues to cause concern in our patients with asthma who benefit from using
Advair.
However, it is still the belief of the doctors of The Allergy Clinic that Advair is safe when used as recommended. The Journal of Allergy
& Clinical Immunology has an editorial by Harold Nelson, MD, the most respected allergist in the country in its December, 2005 issue.
In it, Dr. Nelson defends Advair, stating that "these outcomes (deaths) were not a direct toxic effect of the drugs and increases the
possibility that they resulted from an interaction between relief of symptoms by β2-agonists and delay in seeking medical care."
In other words, it was not the combination drug, Advair, increasing the risk of death. Rather, it was use of Advair's component half,
Serevent, without also using an inhaled steroid. Plus, because stimulant drugs like Serevent and albuterol make your asthma feel better
for a little while, you may postpone the necessary doctor visit to get appropriate treatment.
July, 2005
An advisory panel of the FDA met this month to consider taking Advair off of the market. You can imagine the scare this put into our
patients who are taking that medication, particularly those who are receiving such benefit from it. Bottom line: If you are on Advair, Do
Not Worry! Do Not Stop the drug unless your doctor advises it. The FDA advisory panel unanimously decided not to remove Advair,
Serevent or Foradil from the market.
A little background on this…Advair is actually a combination of two drugs: salmeterol and fluticasone. Each of these was sold alone as,
respectively, Serevent and Flovent. Flovent is an inhaled steroid, and no one is worried about that drug. Serevent, on the other hand, is
a mixed blessing, particularly if it is being used by itself. Serevent is a bronchodilator, similar to albuterol (Ventolin, Proventil). Serevent
has a longer duration of action than albuterol, though. It works for 12 hours instead of 3 or 4 hours. The way that bronchodilators work is
by relaxing the smooth muscle on the outside of the airway. That relaxation allows the airway to open wider and let more air come
through. The relaxation actually takes place because albuterol and salmeterol are “beta agonists” and they stimulate “beta receptors”.
The problem with salmeterol by itself is that when you over-stimulate a beta receptor, your body responds by down-regulating
(decreasing) the production of the beta receptors. Thus, you end up with fewer receptors for those beta agonists to attach themselves to.
Luckily, that problem doesn’t happen when you use an inhaled steroid at the same time you use salmeterol. Advair contains salmeterol
and fluticasone, an inhaled steroid. One important benefit of inhaled steroids is that they up-regulate (increase) the production of beta
receptors. That up-regulation more than offsets the detrimental down-regulation that salmeterol by itself can cause.
Whenever The Allergy Clinic prescribes a long-acting beta agonist such as salmeterol (Serevent) or formoterol (Foradil), we also
prescribe an inhaled steroid to prevent any possible worsening of asthma symptoms. Advair has that beneficial inhaled steroid built in,
so there is usually no need to worry about Advair worsening your asthma.
In summary, Advair has been a wonderful addition in the treatment of asthma. Patients on it should continue using it, but please contact
your medical provider if you have questions. Patients on Serevent or Foradil who are not also using an inhaled steroid should contact
their medical provider as soon as possible to have their condition re-assessed.
DISCLAIMER: The Allergy Clinic offers information of a general nature about the conditions requiring the services of an allergist.
The information is provided with the understanding that The Allergy Clinic is not engaged in rendering surgical or medical advice or
recommendations. Any information in the publications, messages, postings, or articles should not be considered a substitute for
consultation with a board certified allergist to address individual medical needs. Individual facts and circumstances will determine
the treatment that is most appropriate.
