Advair Diskus is an anti-asthmatic, anti-inflammatory, bronchodilatory, glucocorticoid, beta-adrenomimetic agent. It is prescribed for asthma treatment. It is prescriptin drugs which dosage is prescribed by a doctor.
Effective component: salmeterol and fluticasone
This diskus inhaler is a combined preparation containing salmeterol and fluticasone propionate. These two substances have different mechanisms of action. Salmeterol prevents bronchospasm, fluticasone propionate improves lung function and prevents exacerbations. The drugs can be an alternative for patients who simultaneously receive a β2-adrenergic agonist and inhaled GCS.
Salmeterol is a selective long-acting (up to 12 hours) β2-adrenergic receptor agonist with a long side chain that binds to the outer domain of the receptor. The pharmacological properties of salmeterol provide protection against histamine-induced bronchoconstriction and longer bronchodilation (lasting at least 12 hours) than short-acting β2-adrenoreceptor agonists. The onset of the bronchodilator effect is within 10–20 minutes. Salmeterol is a potent and long-acting inhibitor of the release from human lung tissue of mast cell mediators such as histamine, LT and PG D2.
Salmeterol inhibits the early and late phases of the response to inhalation allergens; the latter lasts over 30 hours after the administration of 1 dose, i.e. at a time when the bronchodilatory effect is no longer present. A single administration of salmeterol weakens the hyperreactivity of the bronchial tree. This indicates that salmeterol, in addition to bronchodilatory activity, has an additional effect, the clinical significance of which has not been finally established. This mechanism of action differs from the anti-inflammatory effect of GCS. At therapeutic doses, salmeterol has no effect on CCC.
Fluticasone propionate belongs to the group of corticosteroids for topical use. When administered by inhalation in recommended doses, it has a pronounced anti-inflammatory and antiallergic effect in the lungs, which leads to a decrease in clinical symptoms and in the frequency of exacerbations of diseases accompanied by airway obstruction. This substance restores the patient’s reaction to bronchodilators, allowing to reduce the frequency of their use. The action of fluticasone propionate is not accompanied by adverse reactions characteristic of systemic GCS.
When to apply this diskus?
Treatment of bronchial asthma in patients for whom combination therapy with a long-acting β2-adrenergic agonist and an inhaled corticosteroid is indicated:
- in patients with insufficient control of the disease on the background of constant monotherapy with inhaled corticosteroids with periodic use of a short-acting β2-adrenomimetic;
- in patients with adequate disease control during therapy with inhaled corticosteroid and long-acting β2-adrenergic agonist;
- as a starting maintenance therapy in patients with persistent bronchial asthma (daily onset of symptoms, daily use of drugs for rapid relief of symptoms) in the presence of indications for the appointment of GCS to achieve control over the disease;
- maintenance therapy for COPD in patients with a forced inspiratory volume (FEV1) value <60% of the proper values (before inhalation of a bronchodilator) and recurrent exacerbations in history, in whom severe symptoms of the disease persist despite regular bronchodilator therapy.
What is the dosage of Advair Diskus and how it is applied?
Advair Diskus is intended for inhalation only.
Adults and children 12 years and older: 1 inhalation (50 mcg salmeterol and 100 mcg fluticasone propionate) 2 times a day or 1 inhalation (50 mcg salmeterol and 250 mcg fluticasone propionate) 2 times a day, or 1 inhalation (50 mcg salmeterol and 500 mcg fluticasone propionate) 2 times a day.
In adults over 18 years of age, double dose of this inhaler for up to 14 days remains the same safety and tolerance as with regular use of this combination, 1 inhalation 2 times a day. The dose can be doubled in cases when patients need additional short-term (up to 14 days) inhaled corticosteroid therapy, as described in some guidelines for the treatment of bronchial asthma.
Application during pregnancy and lactation
For pregnant and lactating women, it is recommended to prescribe the drug only if the expected benefit to the mother outweighs any possible risk to the fetus or child.
When is it contraindicated?
- Hypersensitivity to drug components;
- Children under 4 years of age.
The drug is prescribed with caution in the following cases:
- pulmonary tuberculosis;
- fungal, viral or bacterial infections of the respiratory system;
- diabetes mellitus;
- uncontrolled hypokalemia;
- idiopathic hypertrophic subaortic stenosis;
- uncontrolled arterial hypertension;
- prolongation of the QT interval on ECG, CHD;
- coronary artery disease glaucoma;
Possible side effects
Advair Diskus contains salmeterol and fluticasone propionate. It should be expected that the drugs may cause side effects typical of these components. There is no evidence that the concurrent use of salmeterol and fluticasone propionate causes additional side effects.
It may cause paradoxical bronchospasm. In this case, you should immediately apply a short-acting inhaled bronchodilator, discontinue the drug, and start, if indicated, alternative therapy.
Salmeterol: pharmacological side effects of a beta2-adrenergic receptor agonist have been described, such as tremors, palpitations and headache, hypokalemia, which are usually transient and subside with continued therapy with salmeterol.
Arrhythmias (including atrial fibrillation, supraventricular tachycardia, and premature beats) may occur in sensitive patients.
There have been reports of arthralgia, nervousness, abdominal pain, nausea, vomiting, and hypersensitivity reactions including skin rash, peripheral edema, and angioedema.
Cases of irritation of the mucous membranes of the oropharynx, changes in taste sensations (dysgeusia) are described.
There have been reports of painful muscle spasms and very rare cases of hyperglycemia.
Fluticasone propionate: Some patients may experience roughness or hoarseness and candidiasis of the mouth and throat.
Skin hypersensitivity reactions have been described. Hypersensitivity reactions were also reported, manifested in the form of angioedema (mainly edema of the face and oropharynx), respiratory disorders (mainly shortness of breath and/or bronchospasm) and anaphylactic reactions.
The severity and frequency of hoarsening of the voice and candidiasis can be reduced by rinsing the mouth with water after inhalation. Symptomatic candidiasis can be treated with topical antifungal agents while continuing therapy with this bronchodilator.
Very rarely reported on the occurrence of anxiety, sleep disturbance and behavioral disorders, including hyperactivity and irritability (mainly in children); hyperglycemia.
It is theoretically possible to develop systemic reactions, including Cushing’s syndrome, suppression of adrenal function, growth retardation in children and adolescents, decreased bone mineral density, cataracts and glaucoma.
With prolonged use of doses of the salmeterol with fluticasone propionate, which exceed the permitted doses, significant suppression of the adrenal cortex function is possible. There are very rare reports of an acute adrenal crisis, which occurred mainly in children who received greater than permitted doses of this combination for a long time (several months or years); adrenal crisis symptoms included hypoglycemia, accompanied by a decrease in the level of consciousness and/or seizures.
Advair Diskus in children
Children 4 years of age and older: 1 inhalation (50 μg of salmeterol and 100 μg of fluticasone propionate) 2 times a day.
Currently, there is no data on the use of this diskus in children under 4 years of age.
Young children cannot use the inhaler themselves and must be assisted by an adult. It is necessary to wait for the child to exhale and activate the inhaler at the moment the inhalation begins. Practice using the inhaler with your child. Older children and adults with weak hands should hold the inhaler with both hands. In this case, both index fingers should be located on the top of the inhaler, and both thumbs should be on the base below the mouthpiece. For children, the drug is administered using an inhaler through a spacer with a face mask.
Cleaning the inhaler: The inhaler must be cleaned at least once a week. Remove the protective cap from the mouthpiece. Do not remove the metal can from the plastic casing. Use a dry cloth or cotton swab to wipe the inside and outside of the mouthpiece and the outside of the plastic casing. Close the mouthpiece with a protective cap.
Do not dip a metal can in the water.
What are the symptoms of an overdose?
Objective and subjective symptoms of Advair Diskus overdose include tremor, headache and tachycardia. Inhalation of fluticasone propionate doses higher than recommended can cause temporary depression of the hypothalamic-pituitary-adrenal system. This usually does not require any emergency measures, since in most cases, normal adrenal function is restored within a few days.
With prolonged inhalation of excessively large doses, significant adrenal suppression may occur. In the medical research, there are rare reports of an acute adrenal crisis, which occurs mainly in children receiving excessively high doses for a long time (several months or years); an acute adrenal crisis is manifested by hypoglycemia, accompanied by confusion and/or seizures. Situations that can trigger an acute adrenal crisis include trauma, surgery, infection, or a rapid dose reduction in the fluticasone propionate.
How to overcome an overdose when using this inhaler?
Cardioselective β-blockers belong tp antidotes. In cases when it is necessary to cancel the drugs due to an overdose of its contained salmeterol, the patient should be prescribed an appropriate replacement of GCS.
Alcohol and allergens
Alcohol has always been considered a trigger for asthma, but the relation between the two is still poorly understood. One of the largest studies was conducted in the late 1990s in Australia (the report was published in 2000 in the scientific publication The Journal of Allergy and Clinical Immunology). In its base, it was a survey designed to find out what effect alcohol has on the disease course. 350 people answered the pool. It turned out that in 33% of those surveyed, alcohol provoked at least two asthma attacks, and in most cases, symptoms, from mild to moderate, appeared within an hour after drinking.
Researchers have defined two of the most allergenic components of alcoholic beverages that can trigger an asthma attack: sulfur oxide and histamine.
Sulfur oxide, or sulphurous anhydride (the substance is often called sulphites, but from a scientific point of view it is wrong, because sulphites are salts of sulphurous acid), is used as a preservative (food additive E220) in the production of wine and beer. Asthmatics are especially sensitive to this substance.
As a result, it is not recommended to combine any inhalers with alcohol. Alcohol itself causes asthma and medications for bronchial asthma may cause severe side effects.