Advair and Symbicort: FDA Targets These Combination Inhalers in a Recent Bulletin

Advair and Symbicort are combination controller inhalers that have been available for treatment for about a decade. Over the same period of time asthma death rates have decreased from more than 5000 people annually in the U.S. to almost less than 4000. Prior to that time (early 80's to mid 90's) death rates in this country had been increasing.

There is no direct evidence that confirms these inhalers have resulted in fewer deaths from asthma but many asthma specialists are intrigued by the association at a time when the FDA (Food and Drug Administration) is recommending more cautious and shortened use of these inhalants.

Stepping down or off these controller medications (Advair or Symbicort) too soon may in fact result in more difficult to control asthma. My experience is that many of my patients have had fewer months and years of exposure to higher dose inhaled steroids and oral / injectable steroids since Advair and Symbicort have been available.

I agree with the FDA's warning that patients should not be on monotherapy (one drug therapy) with Serevent or Foradil (brands of Salmeterol and Formoterol respectively). There should always be an additional anti-inflammatory controller when these LABAs (Long-acting beta agonist= Serevent and Foradil, which are in Advair and Symbicort respectively) are prescribed.

Advair and Symbicort have steroidal inhalants in them which cannot be separated from the LABA element when they are inhaled. Therefore these medications inherently fulfill the warning criteria proposed by the FDA regarding the avoidance of monotherapy.

A co-writer on AsthmaCentral.com has posted a very nice summary on the recent FDA warnings that I fully agree with. See this link.