Salmeterol-fluticasone (brand name Advair) is an experimental inhalation maintenance treatment used to prevent breathing difficulties such as wheezing, shortness of breath, coughing and chest tightness caused by respiratory disorders. It is a combination of a long-acting bronchodilator (salmeterol) and an inhaled corticosteroid (fluticasone).
Bronchiectasis is a chronic irreversible airway disease. People with bronchiectasis experience shortness of breath, coughing with mucus, and poor quality of life. How effective salmeterol and fluticasone are as a treatment for bronchiectasis has yet to be well studied.
How salmeterol-fluticasone combination works
It is not well known how the salmeterol-fluticasone combination works in people with bronchiectasis, due to lack of research. But in people with COPD, fluticasone, a corticosteroid, works by reducing airway swelling. Salmeterol is a long-acting beta-agonist (LABA) bronchodilator that works by relaxing and opening the airways to the lungs, making breathing easier.
Fluticasone’s anti-inflammatory activity affects disease processes whose inflammatory agents include neutrophils, CD8+ T cells and macrophages.
Salmeterol stimulates an enzyme called adenyl cyclase in the cells of lung muscles known as bronchial smooth muscles. The enzyme helps convert the cell molecule adenosine triphosphate (ATP) to another molecule, cyclic adenosine monophosphate (cAMP). When levels of cAMP increase, muscle cells relax.
A 12-week Phase 4 study (NCT02782312) assessed the effect of salmeterol-fluticasone as an inhaled therapy on lung function, health-related quality of life and exercise capacity in people with non-cystic fibrosis (non-CF) bronchiectasis and chronic airway obstruction.
The study included 32 participants. Some received a combination of salmeterol and fluticasone (50/250 mcg) twice daily through a spacer, and some received a placebo — a substance that contained no medicine. After 12 weeks, the European respiratory journal reported, the salmeterol-fluticasone combination improved lung function and quality of life in people with non-cystic fibrosis bronchiectasis. Researchers used two scales for their measurements: the FEV1 and FVC scale for lung function and the St. Georges Respiratory Questionnaire (SGRQ) for quality of life.
The most common salmeterol-fluticasone side effects are runny nose, sneezing, sore throat, sinus pain, headache, upset stomach — including nausea or diarrhea, muscle and bone pain, dizziness, uncontrolled shaking, and difficulties sleeping.
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