DEAR DR. GOTT: I am a relatively healthy 75-year-old female who leads an active lifestyle. I am concerned that my pulmonary doctor wants to increase my Advair intake from 100/50 to 500/50 because a recent lung infection test revealed a worsening. I am aware that the latest news is that Advair is not recommended for long-term care of asthma. I’ve been on the medication for about 12 years and want to get off it. I’ve not had to take albuterol for several years and do not wheeze unless I have a sinus infection with drainage that gets into my bronchial tubes. This usually happens two to four times a year.
The only medications I take are levothyroxine 0.05 and supplemental calcium, omega fish oil and vitamin D.
What do you recommend regarding the Advair? Do I follow the pulmonary doctor’s advice to increase it, or what?
DEAR READER: The ingredients of Advair are fluticasone and salmeterol. The first is a steroid; the second is a bronchodilator. It is well-known that long-term use of steroids can lead to bone loss and osteoporosis. Those most susceptible are smokers, people who do not get enough exercise and in those with a family history of osteoporosis.
In February 2010, the Los Angeles Times reported the Food and Drug Administration (FDA) wanted to put limits on Serevent, Advair, Symbicort and Foradil. Subsequent to the study, physicians were urged to switch their asthmatic patients from medications that contain such long-acting beta agonists (LABAs). Thus, Advair now comes with a black-box warning on the packaging.
The largest study was known as the SMART trial that revealed a small increase in the risk of death and hospitalization for asthma and breathing problems in patients taking salmeterol. Keep in mind that the SMART trial did not study or target Advair; however, because the product contains salmeterol, the black-box warning was mandated.
Advair is available in three strengths — 100/50, 250/50 and 500/50. Each contains fluticasone in the first strength noted and 50 mcg (micrograms) of salmeterol PER INHALATION. The maximum recommended dose for asthma is 500/50 twice daily. As with many drugs, a person should take as little as possible while obtaining sufficient results.
Here’s where things get sticky. Your pulmonologist knows your complete medical history. I do not. I surmise you have a thyroid abnormality, take calcium and vitamin D to ward off osteoporosis and omega fish oil for heart health. You are in the hands of a specialist. As much as you might not want to hear it, I must defer to his or her guidelines. I do recommend that you make an appointment so you can have your questions addressed. Do not leave the office without obtaining all the information you feel you require. If questions remain, request a referral to a second pulmonologist and bring your medical records with you. If they both agree on the increased dosing, you will have your answer.
To provide related information, I am sending you a copy of my Health Report “Pulmonary Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
About Dr. Gott