Lev0phed

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Can you use Advair HFA with a spacer?

RXlist.com says "Advair HFA is an aerosol form of fluticasone and salmeterol that [blah blah blah]. Use only the inhaler device provided with Advair HFA. This device is not to be used with a spacer."

Yet the pharmacist I asked today said you indeed can.


What is the truth?
 

npage148

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What's the package insert say?
 

RxVampire

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Never heard of this reference being used regularly or reliably...stick to micromedex, clinical pharmacology, lexicomp, & the good old package insert. Use Epocrates with caution (often omits tons of info for drugs).
I'm puzzled as to why RxList states advair hfa should not be used with a spacer

Straight from the PI: "The effect of 21 days of treatment with ADVAIR HFA 45/21 (2 inhalations twice daily with or without a spacer) or ADVAIR DISKUS 100/50 (1 inhalation twice daily) was evaluated in 31 children aged 4 to 11 years with mild asthma. There were no notable changes from baseline for QTc, heart rate, or systolic and diastolic blood pressure."

Lists several other statements acknowledging the spacer can be used & was studied under the pharmacokinetics section
 
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RxList runs along the same lines as Wikipedia and WebMD where some of the information is good, but some can't be trusted. Regardless, never use them as a sole source to make a decision. Agree with the other comments that checking out the package insert is a much more reputable source or sources that use the package insert as a reference (e.g. Micromedex, Lexicomp). So to repeat what's already been said, yes, you may use Advair HFA with a spacer as it has not shown to make any significant difference in efficacy/safety when compared to the more traditional diskus, however it has shown to have more systemic exposure compared to using it without a spacer (which makes sense).

From the PI: Systemic exposure to fluticasone propionate was similar with ADVAIR DISKUS and ADVAIR HFA with a spacer (138 pg•h/mL [95% CI: 69, 273] and 107 pg•h/mL [95% CI: 46, 252], respectively) and lower with ADVAIR HFA without a spacer (24 pg•h/mL [95% CI: 10, 60])

Hope this helps!
 

ldiot

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From the PI: Systemic exposure to fluticasone propionate was similar with ADVAIR DISKUS and ADVAIR HFA with a spacer (138 pg•h/mL [95% CI: 69, 273] and 107 pg•h/mL [95% CI: 46, 252], respectively) and lower with ADVAIR HFA without a spacer (24 pg•h/mL [95% CI: 10, 60])

Hope this helps!
Wow that seems like a big difference. Seems like a strong majority of doctors use diskus anyways though.
 

Ackj

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From the PI: Systemic exposure to fluticasone propionate was similar with ADVAIR DISKUS and ADVAIR HFA with a spacer (138 pg•h/mL [95% CI: 69, 273] and 107 pg•h/mL [95% CI: 46, 252], respectively) and lower with ADVAIR HFA without a spacer (24 pg•h/mL [95% CI: 10, 60])

Hope this helps!
Interesting, but I wonder how non-clinical study, real-world use factors in here. So many can't/don't know how to properly use an HFA without a spacer, so I wonder what their true exposure would be and how that compares to the exposure with the spacer or diskus.