john e russo md replied: "Smoking does not have either a direct nor an indirect effect on Advair but smoking may aggravate the underlying condition for which the Advair was prescribed. Thus smoking may increase your need for your 'rescue' inhaler. The other inhaler which you refer to should be albuterol (Proventil) or its active moiety levalbuterol (Xopenex). Yes there is a concern for using rescue inhalers in addition to Advair but this generally refers to the overuse of such inhalers. To understand this you must appreciate the two medications in Advair which are fluticasone and salmeterol. Fluticasone is an anti inflammatory and as 'asthma' is an inflammatory disorder this is first line therapy. Montelukast (Singulair) is an oral anti inflammatory which works by a different mechanism and may be combined with fluticasone. You will note that albuterol, levalbuterol, and salmeterol all have similar names as they are related drugs. They all contain warnings about the possibility of harm but as above this generally applies using them too often. It was a great development when we developed inhalers that asthmatics could carry with them and it took some time before the obvious sank in. Some patients use their inhalers more and more often as breathing declines and this has resulted in some people seeking medical attention 'too late' resulting in deaths. Nonetheless for periodic use the combination is not only appropriate but may delay symptoms so that you are able to seek medical treatment. Although some people will offer 'rules' as to how many doses per week of rescue inhaler should trigger a call to their physician I have not found this helpful. All asthmatics should have a peak flow meter where you blow into a mouthpiece that measures how much are you are able to exhale. These numbers are then used to tell someone when to restrict activities or environmental exposure, when to use rescue inhalers, and when to visit the physician. Peak flow meters are inexpensive and last indefinitely. I hope that this is helpful and good luck with your smoking cessation efforts. I wish you the very best of health."