I see a number of non-asthmatic patients who use the corticosteroid/beta agonist combination fluticasone/salmeterol (Advair) on an as-needed basis for symptoms of uncomplicated acute viral bronchitis. Is there any validity to this use? Advair is also prescribed frequently for mild persistent asthma in lieu of an inhaled steroid. Am I off base in questioning this practice?
—Jill Holland, ANP-BC, Phoenix
While short-term use of an inhaled steroid may be appropriate in some cases of acute bronchitis, the additional long-acting beta agonist is probably not recommended. Non-asthmatic bronchitis is more inflammatory than constrictive, hence the likelihood that steroids may speed healing.
Patients with mild persistent asthma are appropriately treated with inhaled corticosteroids, and in those older than 5 years, a long-acting beta agonist is a logical and recommended addition. For further discussion, see “NIH releases updated asthma guidelines,” The Clinical Advisor, February 2008.
—Sherril Sego, MSN, FNP (117-10)