Wednesday, July 13, 2016

My thoughts on Advair

If you've been reading my blog the past month or so I've mentioned Advair quite a bit. Here I would like to give you my unadulterated opinion of it. Here goes. 

So, the two ingredients in Advair are salmeterol and fluticasone. Salmeterol is a long acting bronchodilator and fluticasone is a inhaled corticosteroid. Let me tell you about these.

Salmeterol: It was approved by the FDA in 1994. It was in a little green inhaler called Serevent, a little shorter than the albuterol inhaler. Dr. Oliver prescribed this inhaler for me, telling me to take two puffs two times a day, once in the morning and once at night. He said it's basically the long acting version of albuterol. 

Back then my asthma wasn't as controlled as it is today. This was mainly because the inhaled steroid I was on at the time was Azmacort, and it was not very strong, and needed to be taken as four puffs four times a day. So, needless to say, that wasn't possible for a busy 24 year old. 

Most of the time I used it as instructed, but there were times I would use it instead of albuterol as a rescue inhaler. I didn't really do this intentionally, but I remember one night I was having trouble, and I puffed on my inhaler frequently during the night. Then in the morning I realized the inhaler I was using was Serevent. Needless to say, I did not die. 

So this is how I discovered that salmeterol does not kill, as one theory suggests. You know that some asthmatics died clutching a Serevent inhalaler. So, rather than blame the asthma, the inhaler gets blamed. So that's how a black box warning got on long acting bronchodilators like Serevent. 

Now you have warnings on these: "Do not use more than twice a day. Do not use more than instructed." I am fine with this. However, if you go to Canada, they use the Symbicort inhaler as a rescue medicine. It's a program called Symbicort Smart. So, apparently, it's only in the U.S. that LABAs kill. 

My point here is you should not be afraid to use Advair and Symbicort. They are very effective for helping asthmatics obtain ideal asthma control. I'm not saying you should use them more than prescribed. 

I do not like Symbicort or Dulera or Breo. Formoterol makes me too jittery. It is the active LABA in Symbicort and Dulera. Vilanterol, which is in Breo, is also the same. Only salmeterol like me. The disadvantage of salmeterol is it takes 15-20 minutes to open airways, unlike the other LABAs that work immediately. But this is fine with me, because I don't like to feel jittery and shaky. 

Now, I am going to say something that you should never do without talking with your asthma doctor. That is my disclaimer. That said, I have not taken formoterol and vilanterol enough to know if they are safe to use more frequently than most American doctors suggest. Obviously, based on the Symbicort Smart program, Symbicort probably is. but I know from my own personal experience that salmeterol is safe. 

Think of it this way, as my doctor said long ago, all salmeterol is is a long acting version of albuterol, and side effects of albuterol are negligible. It might give you the tremors, but it won't kill you. The same is true of salmeterol. If you need to take an extra puff to end a severe asthma attack, go for it. 

No. Don't go for it if you didn't talk to your doctor. Actually, I personally have never discussed this with my doctor. And this is because I rarely do it. In fact, I have only done it one time in the past five years. One night I was at hunting camp, having a severe allergy/asthma attack, and that extra puff of Advair pulled me out of it.  It took about a half hour, but all of a sudden I could take a deep breath. 

Would I make a habit of doing this. NO. Would I take many puffs of it. NO. Not intentionally, anyway. But the inhaler is not going to kill you. Now, as other experts have noted, the people who die with an Advair or Serevent inhaler in their grasps are those who relied overly on their inhalers when they should have sought for help. So, seek help when you need it! 

I have had this disease for 44 years. I know what works for me. I know that my asthma attacks are not going to kill me. I know an extra puff of Advair will pull me out of my attacks. If they didn't, well then I would seek help. But they almost always do. Plus, because I use it regularly as instructed, my asthma attacks, when they do occur, are relatively mild and easily controlled. 

So, there, that is my personal opinion of Advair. My doctor has this bug up his butt about getting me on something different. So I tried all the other combination inhalers, and they all made me jittery and nervous. So, I am back on Advair, and I will forever be on it -- lacking a cure of course. 

Again, do not use your inhalers the way I do. I just do it the way I do because I am a professional asthmatic. I do not get arrogant and cocky with my medicine. I used to, but that wasn't smart. It wasn't smart to take many puffs on serevent back in 1994. 

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