Key points
- Salmeterol carries a boxed warning: long-acting beta2 agonists increase the risk of asthma-related death, and available data are inadequate to confirm that a concurrent inhaled corticosteroid removes that risk.
- Advair Diskus must not be used to treat acute asthma symptoms; a fast-acting reliever inhaler is needed for those, and patients should keep one available at all times.
- Do not combine Advair Diskus with any additional LABA, including formoterol or arformoterol, for any reason.
How does Salmeterol work?
Salmeterol attaches to beta2 receptors in the smooth muscle lining the airways. A long side chain on the molecule anchors it to a specific site on the receptor, which is why the relaxation it produces lasts at least 12 hours, longer than a quick-relief inhaler.
Because it acts slowly and holds for half a day, salmeterol is a maintenance medicine rather than a rescue one. In Advair Diskus it is combined with fluticasone propionate, an inhaled corticosteroid that reduces the inflammation behind the narrowing, so the two address different parts of the same problem. This pairing sits within Respiratory Health.
Further reading