Advair is a combination of a long-acting bronchodilator (salmeterol) and a corticosteroid (fluticasone) used in preventing asthma attacks. When taken by mouth and in larger doses, fluticasone can cause water retention and weight gain. However, because the dose of fluticasone is very small in Advair and so little is absorbed, weight gain is not likely to be seen. I am not aware of any case reports of weight gain with the use of Advair.

Although both high blood pressure and asthma need treatment, asthma represents the more immediate risk. An acute asthma flare can cause serious harm and even death if it is not properly and promptly treated. The risks related to asthma are ongoing and are present right from the start of symptoms. High blood pressure that is not controlled damages the body, but it usually takes years to decades to cause harm.

The treatment of asthma has undergone a revolution in the past 10 years, with much more attention given to prevention of flares rather than just treating symptoms. There are several categories of drugs that can reliably prevent or reduce the number of asthma attacks in most patients. For example, Advair contains two drugs from different categories. Another different class of asthma control medication is called leukotriene blockers. Singulair (also known as montelukast) is the most commonly prescribed drug in this class. Based on the studies to date, Advair appears to be more effective than Singulair alone in preventing asthma attacks.

Although I am not a fan of combination drugs, Advair may be useful in people with a very stable form of asthma. The problem with combinations like Advair is the inability to adjust the individual doses of the two drugs. Salmeterol dose does not usually vary regardless of how severe asthma symptoms are. On the other hand, the dose of fluticasone is often adjusted up or down depending on how severe asthma symptoms are. Because it is a combination drug, Advair cannot be dose adjusted without purchasing a different strength inhaler.