Can Advair & Spiriva be taken together?

The following question and answer is from a Q&A session at the HealthCentral network.

Question: What is the point of taking Advair and Spiriva together?

My humble answer: Great question. They are both preventative medicines. As you know every person is unique, and one person's asthma may be more difficult to control than another person's asthma. Therefore, it is the job of the doctor to work with you to find the best concoction of medicines to control your asthma.

There are basically your usual front line medicines that are recommended to treat asthma, and your second line medicines that aren't usually needed but sometimes can help control asthma. Advair is a front line medicine because it usually works fine by itself to get asthma under control. If, on the other hand, Advair alone isn't getting the job done, your physician may resort to trying second line medicines like Spiriva.

That said, Advair has both a corticosteroid (Flovent) to treat the underlying inflammation component of asthma, and long-acting bronchodilator (serevent) to prevent the bronchospasm (airway narrowing) component of asthma. Serevent is a beta-adrenergic medicine that causes bronchodilation (relaxes smooth muscles). It attaches to beta receptors in the lungs, and when this happens the lung muscles relax.

Spiriva is a long acting bronchodilator that works by blocking cholinergic receptors in the lungs that cause bronchoconstriction (airway narrowing) when stimulated. Thus, Spiriva is an anticholinergic medicine. In this sense, it is often referred to as a "back-door bronchodilator." It is not as good of a bronchodilator as Serevent, and therefore is a second-line therapy for asthma.

Recent studies, however, do show Spiriva improves lung function in COPD patients and some difficult to control asthma cases. Therefore, if front line asthma medicines like Advair do not control asthma, Spiriva is a good medicine to "try" in conjunction with the recommended front line medicines.

Of course, there's always the chance your doctor has a different reason for prescribing both Advair and Spiriva for you. Therefore, it is always a good idea to talk to your doctor so you are on the same page with him or her.

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