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Fluticasone/Salmeterol (By breathing)

Treats and prevents symptoms of asthma and chronic obstructive pulmonary disease (COPD). This medicine contains a corticosteroid.

What works?

Learn more about the effects of these drugs. The most reliable research is summed up for you in our featured article.

Fluticasone and salmeterol is a combination of two medicines that are used to help control the symptoms of asthma and improve breathing. It is used when a patient's asthma has not been controlled sufficiently on other asthma medicines, or when a patient's condition is so severe that more than one medicine is needed every day. This medicine will not relieve an asthma attack that has already… Read more
Brand names include
Advair, Advair Diskus, Advair Diskus 100/50, Advair Diskus 250/50, Advair Diskus 500/50, Advair HFA, Advair HFA 115/21, Advair HFA 230/21, Advair HFA 45/21, Advair Inhalation Aerosol, Airduo Respiclick
Drug classes About this
Antiasthma, Anti-Inflammatory/Bronchodilator Combination

What works? Research summarized

Evidence reviews

Different combinations of inhaled steroids and long‐acting beta‐agonists for chronic asthma (fluticasone/salmeterol versus budesonide/formoterol)

People with persistent asthma often require an additional treatment to regular inhaled steroids. Some preparations of long‐acting beta‐agonists are delivered in the same inhaler device as the inhaled corticosteroids. Inhaled steroids help to treat inflammation of the airway and long‐acting beta‐agonists help the airway to relax, improving symptoms and lung function. This systematic review examined randomised controlled trials comparing two commonly available combinations administered at a fixed dose through a single inhaler, fluticasone/salmeterol and budesonide/formoterol. We included five studies which recruited 5537 people. The trials were generally well designed but only recruited adults and adolescents and not children. Participants were already taking regular inhaled steroids before the studies commenced and had mild or moderate asthma based on tests of their airway. We found that the number of people who required treatment with oral steroids and admission to hospital was similar between the treatments, but due to the statistical uncertainty of this result we could not rule out important differences in favour of either drug combination. Additional trials would enable us to draw more reliable conclusions about how well these drugs work compared with each other. We also looked at serious adverse events. Again, the results did not indicate that one combination was clearly better than the other, but again these results were imprecise so we cannot be certain. However, lung function and rescue medication use were similar between the treatments. We could not assess the relative effects of these drugs on mortality because there were so few deaths which leads to statistical uncertainty; out of the five studies, one person died. Quality of life was measured in different ways in two studies and we could not determine how the treatments compared in this respect. Further studies are needed to strengthen and better explain these findings. In particular studies which assess the effects of these therapies in children and studies which measure quality of life are a priority.

Do people with asthma have fewer serious adverse events when taking formoterol and inhaled corticosteroids or salmeterol and inhaled corticosteroids?

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an asthma trigger, their airways become irritated and the muscles around the walls of the airways tighten so that the airways become narrower (bronchoconstriction) and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways. These reactions cause the airways to become narrower and irritated ‐ making it difficult to breathe and leading to coughing, wheezing, shortness of breath and tightness in the chest. People with asthma are generally advised to take inhaled steroids to combat the underlying inflammation, but if asthma is still not controlled, current clinical guidelines for people with asthma recommend the introduction of an additional medication to help. A common strategy in these situations is to use a long‐acting beta‐agonists: formoterol or salmeterol. A long‐acting beta‐agonist is an inhaled drug which opens the airways (bronchodilator) making it easier to breath.

Regular treatment with salmeterol and inhaled steroids for chronic asthma: serious adverse events

There has been some concern raised at the possibility of increased serious adverse events following administration of salmeterol, a long‐acting beta2‐agonist, to people with asthma. We analysed data from 35 studies in adults and 5 in children that compared regular salmeterol in addition to inhaled corticosteroids, against the same dose of inhaled corticosteroids. Too few deaths occurred in the trials to gain any conclusive reassurance that regular salmeterol taken with inhaled corticosteroids either reduces the risk of mortality, or in fact does not increase it. The frequency of deaths in the studies was equivalent to around 10 per 10,000 adults or adolescents treated with inhaled corticosteroids and between 3 and 26 per 10,000 when treated with salmeterol and inhaled corticosteroids. No deaths occurred in the studies conducted in children. Serious adverse events were not significantly increased in adults or children when regular salmeterol was added to inhaled corticosteroids as randomised treatment, but the results are too imprecise to conclude that there is no increased risk. The frequency of serious adverse events was 21 per 1000 in the adults treated with inhaled corticosteroids and 24 per 1000 in those treated with salmeterol and inhaled corticosteroids. There were fewer serious adverse events in children, 5 per thousand on inhaled corticosteroids and 6 per 1000 on salmeterol and inhaled corticosteroids. Large surveillance studies are currently ongoing.

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Summaries for consumers

Different combinations of inhaled steroids and long‐acting beta‐agonists for chronic asthma (fluticasone/salmeterol versus budesonide/formoterol)

People with persistent asthma often require an additional treatment to regular inhaled steroids. Some preparations of long‐acting beta‐agonists are delivered in the same inhaler device as the inhaled corticosteroids. Inhaled steroids help to treat inflammation of the airway and long‐acting beta‐agonists help the airway to relax, improving symptoms and lung function. This systematic review examined randomised controlled trials comparing two commonly available combinations administered at a fixed dose through a single inhaler, fluticasone/salmeterol and budesonide/formoterol. We included five studies which recruited 5537 people. The trials were generally well designed but only recruited adults and adolescents and not children. Participants were already taking regular inhaled steroids before the studies commenced and had mild or moderate asthma based on tests of their airway. We found that the number of people who required treatment with oral steroids and admission to hospital was similar between the treatments, but due to the statistical uncertainty of this result we could not rule out important differences in favour of either drug combination. Additional trials would enable us to draw more reliable conclusions about how well these drugs work compared with each other. We also looked at serious adverse events. Again, the results did not indicate that one combination was clearly better than the other, but again these results were imprecise so we cannot be certain. However, lung function and rescue medication use were similar between the treatments. We could not assess the relative effects of these drugs on mortality because there were so few deaths which leads to statistical uncertainty; out of the five studies, one person died. Quality of life was measured in different ways in two studies and we could not determine how the treatments compared in this respect. Further studies are needed to strengthen and better explain these findings. In particular studies which assess the effects of these therapies in children and studies which measure quality of life are a priority.

Do people with asthma have fewer serious adverse events when taking formoterol and inhaled corticosteroids or salmeterol and inhaled corticosteroids?

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an asthma trigger, their airways become irritated and the muscles around the walls of the airways tighten so that the airways become narrower (bronchoconstriction) and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways. These reactions cause the airways to become narrower and irritated ‐ making it difficult to breathe and leading to coughing, wheezing, shortness of breath and tightness in the chest. People with asthma are generally advised to take inhaled steroids to combat the underlying inflammation, but if asthma is still not controlled, current clinical guidelines for people with asthma recommend the introduction of an additional medication to help. A common strategy in these situations is to use a long‐acting beta‐agonists: formoterol or salmeterol. A long‐acting beta‐agonist is an inhaled drug which opens the airways (bronchodilator) making it easier to breath.

Regular treatment with salmeterol and inhaled steroids for chronic asthma: serious adverse events

There has been some concern raised at the possibility of increased serious adverse events following administration of salmeterol, a long‐acting beta2‐agonist, to people with asthma. We analysed data from 35 studies in adults and 5 in children that compared regular salmeterol in addition to inhaled corticosteroids, against the same dose of inhaled corticosteroids. Too few deaths occurred in the trials to gain any conclusive reassurance that regular salmeterol taken with inhaled corticosteroids either reduces the risk of mortality, or in fact does not increase it. The frequency of deaths in the studies was equivalent to around 10 per 10,000 adults or adolescents treated with inhaled corticosteroids and between 3 and 26 per 10,000 when treated with salmeterol and inhaled corticosteroids. No deaths occurred in the studies conducted in children. Serious adverse events were not significantly increased in adults or children when regular salmeterol was added to inhaled corticosteroids as randomised treatment, but the results are too imprecise to conclude that there is no increased risk. The frequency of serious adverse events was 21 per 1000 in the adults treated with inhaled corticosteroids and 24 per 1000 in those treated with salmeterol and inhaled corticosteroids. There were fewer serious adverse events in children, 5 per thousand on inhaled corticosteroids and 6 per 1000 on salmeterol and inhaled corticosteroids. Large surveillance studies are currently ongoing.

See all (15)

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