Common inhaler Flovent is leaving shelves. Here’s how the change may impact patients with co-occuring conditions.

Popular asthma inhaler Flovent is leaving shelves this January. Flovent is a steroid-based inhaler that fights asthma attacks by reducing inflammation in the airway. While Flovent is not the only product of its kind, it has acted as an important line of defense since the 1990s for patients struggling with asthma.^[]

The product’s absence will require patients to reach for other treatment options. Outside of allergists’ offices, the change could have rollover effects for cardiologists and gastroenterologists working with patients with unique diagnoses or co-occurring conditions.

The good news is that GSK, Flovent’s former manufacturer, says it will be releasing a generic version of the inhaler instead of Flovent.

Inhaler use among GI specialties

Babak Firoozi, MD, a board-certified gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, says that certain GI conditions—one noteworthy diagnosis being Eosinophilic Esophagitis (EoE)—warrant the use of a corticosteroid inhaler like Flovent.

EoE can cause heavy inflammation in the esophagus, making it hard, at times, for the patient to swallow or get food to go down their esophagus, Dr. Firoozi says.

“Sometimes you'll get food stuck,” Dr. Firoozi says. “We're not entirely sure why, but there's an inflammatory reaction that happens in the esophagus. Some of it could be related to food [and] some of it could be related to environmental exposure.”

EoE is similar to asthma, as it also causes inflammation in upper areas of the body. But “whereas in asthma it happens in the lungs and eosinophilic esophagitis, it happens in the esophagus” in EoE, Dr. Firoozi says.

Doctors will often prescribe corticosteroid inhalers to people with EoE to fight inflammation and manage the condition, he adds. Still, an inhaler does not cure EOE, and some patients may require more advanced treatment than others.

Other than that, GI doctors shouldn't be too affected by Flovent’s departure, Dr. Firoozi adds. GI conditions don’t typically rely on inhalers, although patients may need the treatment if they are dealing with co-occurring asthma or allergies.

Inhaler use among cardiology specialties

Cheng-Han Chen, MD, a board-certified interventional cardiologist and Medical Director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, says that cardiologists “don't actually use inhalers for cardiac conditions.” But this doesn’t mean that their patients don’t need these tools. 

“The connection comes between patients who do have asthma or COPD and [who] also have cardiac conditions or [are] at risk or having cardiac conditions,” Dr. Chen says.

These patients may need to use an inhaler to manage asthmatic conditions. Furthermore, because the body is interconnected, the way in which a patient’s asthma is or isn’t managed can impact management of their heart condition. 

“If people have an interruption or a change in their inhalers, it may actually end up affecting their cardiac conditions,” says Dr. Chen. “Untreated asthma or COPD can cause extra stress on the heart. It can actually increase their risks of developing a worsening heart condition or developing a new heart condition.”

Dr. Chen adds that with Flovent going off the shelves, it will be important for cardiologists to check in with their patients who experience co-occurring conditions to ensure that they are still accessing a form of treatment that is helpful for them.

“We generally recommend that patients with asthma or COPD stay away from [beta-agonists] because they will increase stress on the heart and could worsen their risk of having a heart attack,” Dr. Chen explains. 

Most doctors should be aware of these risks. The current situation can serve as a reminder to doctors and patients to check in with the full care team before changing medications, Dr. Chen adds. Furthermore, it is important for cardiologists to be aware of their patients’ full health history and recommend that patients see other specialists, like an allergist or pulmonologist, as needed.