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Advice: Advair or Singulair

Hello, I am 30 years old and have been taking Advair to control my asthma for about 11 years. It's worked wonders and I feel my asthma is in control. I recently moved to a new city and saw a new doctor who wanted to switch me to singulair. He did not really give a reason other than Singulair is preventive whereas Advair just treats the symptoms. I am skeptical because I really see no reason to change from what has been working for over a decade. However, I am not too educated on the differences between all these medicines, I have basically just taken what my doctor prescribes. So, obviously, I also want to trust the doctor. Advice? Should I switch and trust the doctor, or go back to him and ask to stay on Advair, third option? Thank you for your time.

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  • K8sMom2002

    Hi, MICD, and welcome!

    I think the first thing I would do is to really learn the differences in what these medications do. 

    is a leukotriene receptor antagonist that inhibits the cysteinyl leukotriene CysLTreceptor. It blocks the action of leukotrienes … Leukotrienes are released from , eosinophils, and and lead to increased , secretions and airway narrowing that causes symptoms.

    is a combination of fluticasone propionate and salmeterol xinafoate, and is a corticosteroid. It reduces the inflammation in the lungs. 

    Singulair is usually not a first-line therapy for asthma. According to the website VeryWell in the article  

    Because Singulair (montelukast) and other leukotriene modifiers are not as effective as , they are not considered a first-line treatment for asthma. However, Singulair (montelukast) and other leukotriene modifiers can be useful if inhaled steroids alone do not control your .

    But your situation may be different, and your doctor may see it as a good and appropriate approach. For instance, my DD was prescribed Singulair for years for her very mild asthma, as well as an inhaler or a neb if she needed a rescue inhaler. She is not currently on an inhaled steroid. 

    I would go back and talk with the doctor about why he believes you need to change medications if the one that you're on is 1) working and 2) having no side effects. 

    It could be that the doctor is looking at your overall health and sees that a change needs to be made. Or it could be that he does not like inhaled steroids and would prefer to see if you could make it without them. 

    ETA link for Advair. – CRR – 03/29/2017

  • K8sMom2002

    And here is an article by the American Academy of Allergy, Asthma & Immunology about . This may help you as well.

  • Micd

    Thank you so much! I will do further research and read that article. What concerned me, and relevant to your response, was that this was my first time seeing this doctor and he did not really inquire into my past with asthma. This was just a routine check-up (he is in family medicine) where I asked to get my Advair refilled and he seemed to immediately want to switch me to Singulair. That is why I sought further guidance, because I knew the doctor was not considering any prior history with me or my asthma (all he knew, essentially, is that I am an otherwise healthy 30 yr old male). Of course I believe he is acting in good faith and has reasons for prescribing Singulair, but I am concerned with changing something so abruptly that has worked for me for so long.

    I will do further research and speak with him more about this issue. I do not experience any side effects of Advair and have not been told of any long term effects. For me it was a miracle drug. I was taking my emergency inhaler at least twice a week my entire life until I started on Advair, have probably used my emergency inhaler once or twice a year since.

  • K8sMom2002

    Glad to help! I can understand why you wouldn't want to rock the boat!

    Any medication can have long-term side effects, so that might be something to talk with your doctor about. Also, do you see a pulmonologist or allergist for your asthma? Even if your asthma is well-controlled, an allergist can really help you. Here's a link to AAFA's video on .

  • Micd

    I do not currently see a pulmonologist but I previously saw the same pulmonologist for about 20 years where I grew up. He is the one that, after years of taking medications that worked so-so, put me on advair. I've never considered seeing an allergist but that sounds like a good idea! The very few times I have used my emergency inhaler as an adult would be in high allergen areas, like camping. Thank you again for the advice!

  • K8sMom2002

    Could you call your previous pulmonologist and ask for a recommendation to either an allergist or a pulmonologist in your new city? 

    Also, I've sent up a flare for some other folks who DO use or have used inhaled steroids, and hopefully they'll be along to chime in. Since we don't use inhaled steroids, I couldn't tell you what the usual plan is for coming off of them. I do know that with oral steroids, there's usually a gradual taper. Not sure about inhaled steroids, which are usually a much lower dose than steroids you take by mouth.

  • Kathy P

    Welcome Mcid. Did the new doc do any lung function tests to assess how well controlled your asthma is right now? It sounds like he didn't. Personally, I'd want that done before switching up meds that seem to be working. Sometimes things can see to ok, but could be better. 

    I was on Advair for many years and it seemed like things were going well. Then last fall, things kept spiralling out of control. Doc had me try a different combo med and had me add Singulair. That combo med did not work (side effects with vocal cord issues). Switched again and things seem better. Sometimes things change and you do need to try different meds or change doses. But it's important that it's based on lung function. 

  • Jen

    Hi micd,

    Welcome to AAFA's asthma support forum.  It sounds like you could use a specialist (ie, pulmonologist or allergist) to help you sort through things.  Since you feel like your current plan is working for you, I completely understand why you are questioning the new doctor's recommendations. I think that a specialist would be  best equipped to handle medicine changes for something like asthma.

  • Micd

    Hello! Thank you for the continued help, this forum is fantastic.

    @Kathy: the doctor did not do any real tests. After he told me to switch to Singulair he held a stethoscope to my chest and had me breathe a few times (I had taken my Advair that morning, about an hour before, so my lungs were pretty much at peak capacity).

    @Jen: I think that is a good idea. Something else relevant to this situation is that I am moving again in a few months to what, I hope, will be a more permanent location. This is also something that worried me about switching right now, since I know I will not have this same doctor for long. I think my best course of action is to continue with what has been working for me for the past 11 years, then making ties with a (hopefully) permanent doctor and pulmonologist in my new location.

    Thank you everyone for the advice and help!

     

  • K8sMom2002

    It sounds like you've worked through your options and figured out the thing that will work for you!

    Is the place you'll be moving to close enough that you could go ahead and establish yourself as a patient with a pulmologist or allergist there? Sometimes it can take a while to get an appointment with a specialist. 

  • Kathy P

    Are you able to get refills for your current meds to hold you til you move and find new docs?