Expert: Marc Rubin, RPh Asthma Educator - 6/15/2009

Question
i saw that flovent will work if you have mild asthma but i am a severe chronic asthmatic  on the highest dosage of advair. how would switching to flovent help me?

Answer
Hi Mia,

The steroid medication in Flovent, fluticasone, is the same medication that medication in Advair, but with the bronchodilator salmeterol added for a greater benefit.

Asthma severity is approached in a step up pattern. If the patient has persistent asthma, that is, requiring rescue with albuterol (Pro-Air HFA, Proventil HFA, Ventolin HFA, etc) more than 2x/week in the daytime, or 2x/month during the night, then we need to begin treatment with a "controller" medication that is taken on a daily basis.

The beginning step, per guidelines, is generally a steroid inhaler such as Flovent or Pulmicort. Typically, if the initial evaluation is of a higher severity, a step up to a product like Advair or Symbicort, where a steroid is combined with a long-acting agent to open the lungs is used. The patient is generally to be re-evaluated after 2 to 6 weeks to see if adjustments need to be made in the dosage, or the addition/subtraction of the present approach. You need to evaluate if the patient also needs an antihistamine like Claritin, or a nasal spray like Flonase or Nasacort. If the patient also has nasal symptoms, but the nose is not treated, the nasal inflammation will trigger the lungs to react.

Anther issue you need to be aware of is the fact that not all patients respond to the medications the same way. Some patients do not respond to inhalation steroids. Other patients do not get relief with albuterol, but do get relief with Atrovent inhalers, which belong to a different chemical family. It has a lot to do with genetics. Like clothing, one size does not fit everyone.

I'll make an assumption that you are not presently seeing an allergy specialist. One important aspect of the asthma guidelines, and really all medical guidelines, is that if the family physician cannot get the patient under control with some basic steps to therapy, they need to refer you to a specialist. It is completely impossible for a general practitioner to master ALL disease states. There are not enough hours in our lifetime to constantly stay at the cutting edge in all areas of medicine, actually see patients, and have any resemblance of a life.

I hope this helps you. If you need some guidance in finding an allergy specialist, go to : http://www.aaaai.org/physref/

Also, here is a tool to help you monitor how you are doing:
http://www.asthmacontrol.com/

Good luck!

Marc