Advair for Kids

Asthma Basics

A Child Using Advair
Advair Diskus is a dry powder inhaler. Photo by Vincent Iannelli, MD licensed to, Inc.

Advair contains two medications, a steroid, and a long-acting bronchodilator, and is taken twice a day, every day, to help prevent asthma attacks and improve lung function.

Advair For Kids With Asthma

Advair is used as a maintenance treatment for children and adults with asthma. It is also used for adults with Chronic Obstructive Pulmonary Disease (COPD) associated with chronic bronchitis. If your child is having frequent asthma symptoms, asthma attacks, and/or is frequently using his asthma control or rescue medicines, like Albuterol or Xopenex, then he may need a medicine like Advair.

Advair should NOT be used for the relief of acute bronchospasm, which means that you should not use it as a rescue medicine when your child is having an asthma attack or shortness of breath. A short-acting beta2-agonist, like Albuterol, should be used instead when your child is having an asthma attack.

Advair contains

  • Advair contains Flovent or fluticasone propionate, a corticosteroid that reduces airway inflammation, and Serevent or salmeterol, a long-acting bronchodilator that helps relax the muscles that surround airways
  • Advair should be used when an inhaled corticosteroid alone, such as Flovent, Pulmicort, or Asmanex, doesn't control your child's asthma or when it is mild enough to be controlled with just the very occasional use Albuterol or Xopenex
  • Asthma inhalers that are similar to Advair include Dulera and Symbicort

Two forms of Advair asthma inhalers are available, with each available in multiple strengths:

  • Advair Diskus 100/50
  • Advair Diskus 250/50
  • Advair Diskus 500/50 (strongest)
  • Advair HFA 45/21
  • Advair HFA 115/21
  • Advair HFA 230/21 (strongest)

While the '50' and '21' refers to the strength of salmeterol and stays the same in each form of Advair, the strength of the steroid varies.

Advair Side Effects and Warnings

Advair is usually well tolerated by children.

The most common side effects include upper respiratory tract infections, throat irritation, ear, nose, and throat infections, epistaxis (nosebleeds), pharyngitis (throat infections), ear signs and symptoms, sinusitis, headaches, gastrointestinal discomfort and pain, nausea and vomiting, candidiasis of the mouth or throat, fever, and chest symptoms.

The FDA has issued an alert that long-acting beta-agonists, including salmeterol, may increase 'the chance of severe asthma episodes, and death when those episodes occur.' Keep in mind that these episodes were rare and you should weigh the risk of having uncontrolled or poorly controlled asthma and not taking Advair if your child's asthma is not controlled with an inhaled corticosteroid alone.

There are also warnings about hypercorticism and adrenal suppression, cytochrome P450 3A4 inhibitor drug interactions, allergic reactions in kids with severe milk allergy, reduction in bone mineral density, a reduction in growth velocity, and glaucoma and cataracts, etc.

What To Know About Advair for Kids

Although approved for children over age 4, some children under age 5 or 6 have a hard time using the breath-activated Advair Diskus. Alternative asthma controllers might include Pulmicort Respules, that can be given with a nebulizer, or using a steroid MDI with a spacer and mask.

Other important information:

  • your child should likely step up or down on his dose of Advair depending on how well his asthma is being controlled
  • it is not uncommon for some children to say that they can not taste or feel the dose of Advair Diskus when they take it
  • do not exceed the recommended dose of one inhalation twice a day
  • kids should rinse out their mouth after using Advair and other asthma inhalers that contain a steroid
  • even older children should likely use a spacer when using Advair HFA or a steroid inhaler

Although not formally approved for children under age 12 years, Advair HFA is routinely prescribed off-label by many pediatricians for kids with asthma.


FDA. Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) -- April 2008

NIH. Asthma Clinical Practice Guidelines. Guidelines for the Diagnosis and Management of Asthma. 2007

State of Childhood Asthma and Future Directions Conference: Overview and Commentary. March 2009, VOLUME 123 / ISSUE Supplement 3.

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