flovent vs singulair

[bulldog]

I haven't had chance to do much reading regarding the two but jist of things i've read is that flovent (inhaled corticosteroid/fluticasone) has been found to be more effective than singulair in long term tx/maintenance for asthma. If so, what are the side fx of long term flovent use (i.e. can someone use it more than a month) and why singulair is so popular these days. if anyone knows a good pubmed article, let me know. i've just been able to pull up short articles that say cortisteroids first line therarpy but doesn't say anything re long term fx, dosing, tapering, etc. thanks.

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[TheCat]

more than a month? Flovent and those alike can be used for years and years with no complications other than maybe some increased risk of infections. Some poeple are on those inhaled steroids for decades. Singulair is just a differnet medication and is not indicated really for the same use. I think right now singulair is not indicated for monotherapy of asthma although some docs are trying it. From my experience seeing patients it is not nearly as effective in moderate-severe cases as the steroids.

 

[Claymore]

Inhaled steroids are absolutely first line therapy. In my experience leukotriene antagonists are only used in patients with a significant allergic component to their asthma, and even then, the efficacy is questionable.

 

[DarksideAllstar]

As someone with allergy-induced asthma, I would never let a physician place me on singulair monotherapy. In fact, I took singulair when its label use was strictly for controlling allergies, and it was simply sub-par when compared to other prescription anti-histamines that I had previously used. Plus, singulair isnt really going to help prevent an attack from occuring, which is what the corticosteroids are used for.

I have been on a Flovent/salmeterol for more than a decade, most recently in the form of Advair. I think the biggest side effect with the inhaled corticosteroids is oral thrush, which I can say I have never had.

Depending on the severity of one's asthma and what induces an attack, some people do not require inhaled corticosteroids, and can manage with a short acting inhaled B2 agonist (like albuterol) when exercising.

 

[bulldog]

As someone with allergy-induced asthma, I would never let a physician place me on singulair monotherapy. In fact, I took singulair when its label use was strictly for controlling allergies, and it was simply sub-par when compared to other prescription anti-histamines that I had previously used. Plus, singulair isnt really going to help prevent an attack from occuring, which is what the corticosteroids are used for.

I have been on a Flovent/salmeterol for more than a decade, most recently in the form of Advair. I think the biggest side effect with the inhaled corticosteroids is oral thrush, which I can say I have never had.

Depending on the severity of one's asthma and what induces an attack, some people do not require inhaled corticosteroids, and can manage with a short acting inhaled B2 agonist (like albuterol) when exercising.

thanks for info. i've been reading about asthma and it initially seemed strange that people would be on long term inhaled corticosteroid while long term PO corticosteroids like prednisone is a no-no. gets there's not much systemic absorption.

 

[DarksideAllstar]

thanks for info. i've been reading about asthma and it initially seemed strange that people would be on long term inhaled corticosteroid while long term PO corticosteroids like prednisone is a no-no. gets there's not much systemic absorption.

Yeah, I posed this question to my family medicine preceptor last year and we both looked into it and it seems that there aren't the same risks (ie osteoporosis, DM, etc) with the inhaled as there are with the PO.

 

[AJM]

thanks for info. i've been reading about asthma and it initially seemed strange that people would be on long term inhaled corticosteroid while long term PO corticosteroids like prednisone is a no-no. gets there's not much systemic absorption.

There is very little systemic absorption with inhaled corticosteroids, which is why it's preferred over prednisone. That said, there still is some absorption, especially with high-dose inhaled steroids, but not enough absorption to cause side-effects such as HTN, DM, or psych symptoms. There was a study that showed that people who were on long-term high-dose inhaled corticosteroids had lower bone density than those who were not, but it's unclear whether it would result in any clinically significant osteoporosis.

That said, even one 10-14 day course of po prednisone causes more bone loss than years of high-dose inhaled corticosteroid therapy.

The most common side effects of inhaled corticosteroids are a sore throat and oral thrush, both of which are easily avoided by using a spacer and rinsing your mouth after using the inhaler.

FYI - no pulmonologist in their right mind would ever put any patient with more than mild intermittent asthma on singulair monotherapy. If anything, singulair is used in combination with other meds. The only reason it's so popular these days is because of marketing -- people are seeing the commercials, and then asking their PCPs for the med thinking that it's a cure-all. BTW, I just saw a patient in my clinic the other day who had moderate persistent asthma, who was referred to me from her allergist because she was a 'difficult to control' asthmatic. I was shocked to see that the only med the allergist had her on was singulair -- the allergist had specifically stopped her flovent even though it was working, and she wasn't even on a long-acting beta agonist! I would have thought that an allergist would know better than that....

 

[TheCat]

There is very little systemic absorption with inhaled corticosteroids, which is why it's preferred over prednisone. That said, there still is some absorption, especially with high-dose inhaled steroids, but not enough absorption to cause side-effects such as HTN, DM, or psych symptoms. There was a study that showed that people who were on long-term high-dose inhaled corticosteroids had lower bone density than those who were not, but it's unclear whether it would result in any clinically significant osteoporosis.

That said, even one 10-14 day course of po prednisone causes more bone loss than years of high-dose inhaled corticosteroid therapy.

The most common side effects of inhaled corticosteroids are a sore throat and oral thrush, both of which are easily avoided by using a spacer and rinsing your mouth after using the inhaler.

FYI - no pulmonologist in their right mind would ever put any patient with more than mild intermittent asthma on singulair monotherapy. If anything, singulair is used in combination with other meds. The only reason it's so popular these days is because of marketing -- people are seeing the commercials, and then asking their PCPs for the med thinking that it's a cure-all. BTW, I just saw a patient in my clinic the other day who had moderate persistent asthma, who was referred to me from her allergist because she was a 'difficult to control' asthmatic. I was shocked to see that the only med the allergist had her on was singulair -- the allergist had specifically stopped her flovent even though it was working, and she wasn't even on a long-acting beta agonist! I would have thought that an allergist would know better than that....

Well her being on a long act beta means nothing. If she wasnt even on steroids she should not have been. I am sure you know the drill but first line is steroids alone-followed by addition of the long beta.

 

[AJM]

Well her being on a long act beta means nothing. If she wasnt even on steroids she should not have been. I am sure you know the drill but first line is steroids alone-followed by addition of the long beta.

My point was that not only did the allergist stop the ICS, but he did not make any effort to add medications despite her having persistent symptoms. I know that first line is ICS - that was why I had mentioned this patient in the first place. But, if you decide not to treat with ICS for one reason or another (again, I don't know why the allergist took her off the inhaled steroids), then you have to make sure that symptoms are controlled by using a combination of other meds at your disposal. If singulair isn't cutting it by itself, then you add a long-acting beta agonist to the regimen, and so on.

I know that long acting beta agonists should not be used as first-line therapy, but this patient was not on a first-line regimen pathway. (more like 3rd or 4th line).