Expert: Marc Rubin, RPh Asthma Educator - 6/27/2009

Question
In January I was hospitalized for pneumonia.  At that time my doctor changed my medication from Flovent to Advair.  Whie it appears to help my breathing I am experiencing extreme hair loss as well as sores in my mouth.  I talked with my doctor about it and he lowered my dosage from 500mg twice daily to once daily.  I continue to experience the above mentioned symptoms.  Would it be safe for me to quit taking the Advair and revert back to the Flovent?  Can I stop the Advair "cold turkey" or is there a weening off period?

Answer
Hi Carol,

Apparently my original response 3 days ago did not make it to you. It is a glitch that happened once before ..Sorry for the delay.

I need some more history from you to give a valid answer:

1) How old are you, and have you been previously diagnosed with asthma?
2) Do you smoke, and if yes, for how long?
3) What other medications are you currently on?
4) Is the prescribing physician a general practitioner, or a specialist (allergist or pulmonologist)?
5) Did anyone properly demonstrate the technique to be used for an Advair Diskus, and then observe you to be sure it was done correctly?
6) What was the dose of Flovent you were taking prior to being switched to Advair?

Hair loss. as you describe, is not something seen with Advair. I did a literature search, but it failed to show anything like you are exhibiting. This should be looked into further, as there are a number of reasons for what you are dealing with.

Regarding the mouth sores, that is another story, and goes directly to my question above regarding technique. Unlike your Flovent MDI, which calls for a slow, full inhalation, dry powder inhalers required a quick, deep inhalation, less there be medication deposited in the mouth. This would increase the risk of sores, thrush, hoarseness, etc.

Once you clarify the above questions for me, I'll be better able to guide you.

Again, sorry for the delay.

Sincerely,

Marc