3. There is no ICS/tiotropium combination inhaler (yet). One of the advantages to ICS/LABA combination inhalers is that both medications come in a single inhaler. This is critical. As mentioned, the LABA safety issues seems to occur when patients take LABA’s without an ICS. This makes sense because even though the bronchodilator might make patients feel better, not treating the disease (inflammation) can lead to serious problems down the line. Because of this, the FDA recently recommended that children who take ICS and LABA’s together only take them in the same inhaler. The worry is that if the two inhalers are used separately, patients are at risk of only taking the bronchodilator. Because the bronchodilator makes patients feel better, they are more likely to be adherent to this inhaler than an ICS, which has effects that patients don’t immediately notice. This same concern would be true of tiotropium, which is also a bronchodilator. However, ICS/anticholinergic combination inhalers should be available soon. Studies will be now needed not only in COPD, but also in asthma to see which regimen produces the best benefit.
Advair (Fluticasone + Salmeterol) : The original combination inhaler is still the most popular. Basically it combines a steroid with a long acting beta adrenergic (LABA). The steroid controls inflammation while the LABA keeps your lungs relaxed around the clock. The combination of these medicines has worked wonders for many asthmatics. The best part of this medicine is all you need to do is take one puff in the morning and one before bed. This greatly improves complaince, and that alone I think has benefited many asthmatics.