Fluticasone Inhalers

1. Introduction

Fluticasone inhalers are inhaled corticosteroids (ICS) used to manage and prevent asthma and chronic obstructive pulmonary disease (COPD). They reduce airway inflammation, swelling, and mucus production, improving symptoms and reducing exacerbations. Regular use helps control respiratory conditions over the long term.

2. Indications

  • Approved Indications:
    • Asthma (maintenance therapy in adults and children).
    • Chronic obstructive pulmonary disease (COPD) as part of combination therapy with long-acting bronchodilators.
  • Off-Label Uses:
    • Eosinophilic bronchitis (under specialist advice).

3. Dosage

  • Adults and Adolescents (≥12 years):
    • Asthma:
      • Low dose: 100–250 mcg twice daily.
      • Medium dose: 250–500 mcg twice daily.
      • High dose: 500–1000 mcg twice daily.
    • COPD (in combination therapy):
      • 500 mcg twice daily (in combination inhalers).
  • Children (4–11 years):
    • Asthma:
      • 50–100 mcg twice daily.
  • Children (<4 years):
    • Use only under specialist supervision; dose adjustments vary.

4. Administration

  • Inhale as prescribed using a metered-dose inhaler (MDI) or dry powder inhaler (DPI).
  • Rinse your mouth with water and spit it out after each use to reduce the risk of oral thrush.
  • Shake the inhaler well before use (for MDIs).

5. Forms Available

  • Metered-Dose Inhaler (MDI): 50 mcg, 100 mcg, 125 mcg, 250 mcg per puff.
  • Dry Powder Inhaler (DPI): 50 mcg, 100 mcg, 250 mcg per dose.
  • Combination Inhalers (with long-acting beta-agonists, e.g., salmeterol): Various strengths.

6. Side Effects

6.1. Common Side Effects

  • Hoarseness (dysphonia).
  • Oral thrush (oropharyngeal candidiasis).
  • Sore throat.

6.2. Less Common Side Effects

  • Cough or throat irritation after inhalation.
  • Dry mouth.

6.3. Rare but Serious Side Effects

  • Adrenal suppression (with high doses or prolonged use).
  • Growth suppression in children (with prolonged use).
  • Allergic reactions (e.g., rash, swelling).

7. Warnings

  • Oral Thrush: Rinse your mouth after each use to minimise the risk of fungal infections.
  • Adrenal Suppression: Monitor if using high doses for prolonged periods.
  • Growth Suppression: Monitor growth in children on long-term therapy.

8. Precautions

  • Use cautiously in patients with a history of tuberculosis or untreated infections.
  • Regularly monitor lung function and asthma/COPD symptoms to adjust therapy.
  • Avoid abrupt discontinuation, as it may worsen symptoms.

9. Interactions

  • Drug-Drug Interactions:
    • Strong CYP3A4 inhibitors (e.g., ritonavir, ketoconazole): May increase systemic corticosteroid levels, leading to side effects.
    • Other corticosteroids: Increased risk of systemic side effects.

10. Monitoring Parameters

  • Symptom control (e.g., frequency of asthma attacks or COPD exacerbations).
  • Signs of oral thrush or hoarseness.
  • Growth in children during prolonged use.
  • Adrenal function if using high doses long-term.

11. Use in Children

  • Approved for asthma in children aged 4 years and older, with dose adjustments based on age and severity. Monitor growth during long-term use.

12. Use in Pregnancy

  • Category C: Use only if the benefits outweigh the risks. Inhaled corticosteroids are generally preferred for asthma control during pregnancy.

13. Use in Elderly

  • Safe for use in elderly patients, but monitor for potential side effects such as hoarseness or oral thrush.

14. Use in Kidney Disease

  • No dose adjustment required, as fluticasone is not renally excreted.

15. Use in Liver Disease

  • Use cautiously in severe liver impairment, as systemic absorption may be increased with high doses.

16. Patient Counselling Points

  • Use your inhaler regularly as prescribed, even if you feel well, to maintain control of asthma or COPD.
  • Rinse your mouth after each use to reduce the risk of oral thrush.
  • Learn the proper inhaler technique to ensure the medication reaches your lungs effectively.
  • Inform your doctor if you experience worsening symptoms or require your reliever inhaler more frequently.
  • Do not stop using fluticasone abruptly without consulting your doctor.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
FloventGlaxoSmithKline$200–250 (120 doses, 125 mcg)
Arnuity ElliptaGlaxoSmithKline$300–350 (30 doses, 100 mcg)
Generic FluticasoneVarious$50–100 (120 doses, 125 mcg)

18. FAQs (15 Questions)

  1. What is fluticasone used for?
    Fluticasone is used to prevent and manage asthma and COPD symptoms.
  2. How does fluticasone work?
    It reduces airway inflammation, swelling, and mucus production, improving breathing.
  3. How long does it take for fluticasone to work?
    It may take a few days to notice improvement and up to 2 weeks for full benefits.
  4. What are the common side effects of fluticasone?
    Common side effects include hoarseness, oral thrush, and sore throat.
  5. How should fluticasone inhalers be used?
    Inhale as prescribed, rinse your mouth after use, and follow proper inhaler technique.
  6. Can fluticasone be used during pregnancy?
    Yes, if prescribed. It is generally safe for asthma control during pregnancy.
  7. Can children use fluticasone inhalers?
    Yes, it is approved for children aged 4 years and older for asthma.
  8. Can I stop using fluticasone once I feel better?
    No, continue using it as prescribed to maintain long-term control of your condition.
  9. Can fluticasone cause weight gain?
    No significant weight gain is associated with inhaled fluticasone, unlike oral corticosteroids.
  10. What should I do if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up.
  11. Does fluticasone interact with other medications?
    Yes, CYP3A4 inhibitors like ritonavir may increase its systemic levels.
  12. How should fluticasone inhalers be stored?
    Store at room temperature, away from direct sunlight and moisture.
  13. Can I use fluticasone during an asthma attack?
    No, it is a maintenance inhaler and not a rescue medication. Use a reliever inhaler for attacks.
  14. Does fluticasone cause adrenal suppression?
    Adrenal suppression is rare but may occur with high doses or prolonged use.
  15. How often should I clean my inhaler?
    Clean the mouthpiece weekly to prevent medication buildup and ensure proper function.