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Advair is a relatively new and popular medication for controlling Asthma which is known for its distinctive purple inhaler, the "Advair Diskus". The medication itself consists of fluticasone propionate and salmeterol (as salmeterol xinafoate salt) and comes in three dosages, expressed as quantities of fluticasone proprionate and salmeterol in that order, in micrograms; 100/50, 250/50, and 500/50. It is taken twice per day, twelve hours apart, typically once upon awakening and then again in the evening.

Fluticasone proprionate is a mild corticosteroid and potent anti-inflammatory, and salmeterol xinafoate is a selective bronchodilator. As the product documentation says, "Corticosteroids have been shown to inhibit multiple cell types (e.g., mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils) and mediator production or secretion (e.g., histamine, eicosanoids, leukotrienes, and cytokines) involved in the asthmatic response. These anti-inflammatory actions of corticosteroids contribute to their efficacy in asthma." As for salmeterol, "The pharmacologic effects of beta2-adrenoceptor agonist drugs, including salmeterol, are at least in part attributable to stimulation of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'--adenosine monophosphate (cyclic AMP). Increased cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells."

As mentioned previously, it is really the packaging that this drug is known for. Since the drugs are best packaged and distributed in powder form, a method for accurately and consistently controlling dosage was needed. The Advair Diskus is purple in color and about the size of a hockey puck, though with a rounded edge. Placing your thumb in the appropriate notch and sliding the inner portion exposes a lever and a mouthpiece. The Diskus is held horizontally and the lever is cocked, then the user inhales deeply through the mouthpiece without tilting the Diskus.

Inside the Diskus, the drugs are stored in a strip of blister pack reminiscent of exploding roll caps used in some cap guns. There is one blister for each dose; There are 60 doses per Diskus, or 28 doses in the trial version. When the lever is pressed, the blister pack roll is wound onto a spool and the next blister is popped by a sharp plastic protrusion. At the same time, a short sequence of gears advances the dose remaining indicator, which is a ring which runs around the inside of the inner portion of the Diskus.

After using the Diskus, it is important to fully rinse the mouth, as otherwise the steroids may lead to increased growth of the already-present bacteria in the mouth, possibly leading to infections of the ear, nose, and/or throat. It can also cause an oral thrush infection, which is caused by yeast.On the other hand, the Diskus itself must be kept dry, as one inhales powder and not liquid or vapors from it.

Advair does not replace so-called "rescue inhalers", but should not be used with any other asthma medication which has long-term effects. It is perfectly acceptable (and indeed common practice) to combine Advair as the daily routine for maintenance with an Albuterol (Commercially, Ventolin) inhaler for rescue use.

My personal experience with Advair has been generally positive. My "wind" capacity has increased and the symptoms of asthma generally do not last as long and are not as severe as without the drug. In addition my albuterol rescue inhaler has been more effective when needed, possibly due to partial management of symptoms by Advair. The Diskus is extremely convenient, and amusing to disassemble when all doses have been depleted. The need to keep the inhaler dry (unlike traditional inhalers) is awkward but not impossible or particularly difficult.


References:

  1. Advair Diskus Prescribing Information 4150163. August 2002, GlaxoSmithKline.

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