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ICS/LABA — Asthma / COPD Pregnancy: Continue if established and providing good control — poorly controlled asthma is more harmful to fetus

Beclometasone / Formoterol

Brand names: Fostair 100/6, Fostair 200/6, Luforbec

Adult dose

Dose: 1–2 inhalations of 100/6 mcg twice daily (asthma) or 1 inhalation 100/6 mcg twice daily (COPD)
Route: Inhaled MDI or NEXThaler DPI
Frequency: Twice daily
Max: 4 inhalations/day of 100/6 mcg (400/24 mcg/day)
Extra-fine particle ICS/LABA combination — high small airway deposition. SMART (Single Maintenance And Reliever Therapy) use possible with Fostair — use as both regular maintenance AND reliever inhaler (1–2 puffs PRN). GINA 2023 recommends AIR therapy (anti-inflammatory reliever) for Step 1–2.

Paediatric dose

Dose: 1–2 inhalations of 100/6 mcg twice daily mcg/kg
Route: Inhaled MDI
Frequency: Twice daily
Max: 4 inhalations/day
Licensed from 18 years in UK for asthma; specialist use in adolescents ≥12 years in some guidelines

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Licensed from 18 years in UK for asthma; specialist use in adolescents ≥12 years in some guidelines

Clinical pearls

  • GINA 2024: AIR (anti-inflammatory reliever) therapy — Fostair used as both regular maintenance AND reliever inhaler; reduces exacerbations vs SABA reliever even at Step 1
  • Extra-fine particle technology: ~50% lung deposition vs ~20% for standard MDI — higher small airway penetration particularly important in small airway disease and COPD
  • SMART therapy advantage: reduces total ICS dose by increasing dose only when symptoms worsen — superior exacerbation prevention vs fixed dose + SABA (COSMOS trial)
  • Fostair NEXThaler: breath-actuated DPI version — no spacer needed; good for patients with coordination difficulties
  • Not interchangeable with Symbicort (budesonide/formoterol) for SMART use on a mcg basis — different molecules and particle sizes

Contraindications

  • Acute asthma attack (not suitable as sole rescue medication)
  • Hypersensitivity to beclometasone or formoterol

Side effects

  • Oropharyngeal candidiasis
  • Tremor (formoterol component)
  • Palpitations
  • Headache
  • HPA axis suppression (high doses)

Interactions

  • CYP3A4 inhibitors — increased beclometasone exposure
  • Beta-blockers — antagonise formoterol
  • QT-prolonging drugs — additive QTc risk with high-dose formoterol

Monitoring

  • Symptom control
  • Exacerbation frequency
  • Inhaler technique
  • Oral candidiasis

Reference: BNFc; BNF 90; GINA 2024; COSMOS Trial; BTS/SIGN Asthma Guidelines 2019; SPC Fostair. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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