Expert: Marc Rubin, RPh Asthma Educator - 7/1/2009

Question
I have been sick with brochitis for two weeks. The end of the illness left me with asthma symptoms (tightness of chest, deep dry cough, etc)which cleared up about 90% after I took some of my husband's ventolin (I have never had asthma before). I went to my doctor, and she put me on Advair to reduce the inflammation, but did not prescribe any ventolin for me. After taking it once I did not feel good--dizziness, hard time catching my breath, etc. I read the warnings and became concerned. Is this really the right med for my condition? I'm wondering if flovent would be better....

Answer
Hi Lisa,

There is the possibility that the salmeterol in the Advair may have caused the problem. (That issue is separate from the "Black Box" warning in the sense that the warning came about from a poorly run study where asthma patients, rather than being put on the combo of Advair, were instead put on the two drugs in separate dispensing devices. A number of patients, on their own, stopped taking the steroid product[fluticasone/Flovent] since they noticed the salmeterol made them feel better, and didn't think the fluticasone did anything. Since salmeterol is only a bronchodilator, there was no reduction in lung inflammation, and the actual asthma condition worsened, and in some cases, lead to their deaths. This led to guideline changes in asthma (but not COPD), where you should never prescribe the individual long-acting bronchodilator w/o being in combination with the inhalation steroid).

As to appropriateness of therapy, I could see where your doctor would rightly expect to see improvements in both your breathing due to the long-acting salmeterol (which is a 12 hour version of Ventolin), as well as a reduction in your lung inflammation with the bronchitis, compliment of the fluticasone. A problem with this approach, aside from the fact you had an adverse effect from the salmeterol, is that inhalation steroids take ~ 4 weeks to truly become effective. It is a building process, not an immediate change. So taking Flovent, which contains the steroid that is in Advair, would not be rapid acting enough to really be beneficial. A short course of oral prednisone (for 3-10 days) would have reversed the inflammation beginning about 8 hours after the first dose. This, with Ventolin, would be an appropriate alternative choice.

Keep in mind a couple of things:
1) I really don't know your full medical history, which your physician does have,
2) You probably do not have asthma, it is just that bronchitis presents with similar symptoms (that can last for 6 weeks). When you fully recover, you may wish to have proper lung testing by a specialist to verify this.
3) With the development of the bronchitis, whether it was due to bacteria or a virus, you should make sure that you get your pneumococcal vaccine and annual flu vaccine. You may find yourself more prone to bronchitis in the future.

I hope this helps, and that you feel better soon.

Sincerely,

Marc