Fluticasone with formoterol

How it works

Fluticasone propionate reduces airway inflammation via glucocorticoid receptor activation, while formoterol produces both rapid-onset and sustained bronchodilation through beta2 adrenoceptor stimulation.

Prescribing in practice

• The long-acting beta2 agonist component must only be used together with the inhaled corticosteroid and not as sole asthma therapy, as long-acting beta2 agonist monotherapy increases the risk of severe asthma events.
• Local effects include oral candidiasis and hoarseness, mitigated by mouth rinsing after use.
• Systemic beta2 agonist effects include tremor, palpitations and hypokalaemia, with caution in cardiac disease and concurrent QT-prolonging drugs.

Monitoring

Monitor asthma control, inhaler technique, and in long-term use growth in children and signs of systemic corticosteroid exposure.

Counselling the patient

• Take regularly every day even when feeling well.
• Rinse and spit after inhaling to prevent thrush.
• Keep a separate reliever inhaler for acute symptoms.

Evidence & guidelines

A recognised inhaled corticosteroid/long-acting beta2 agonist asthma combination supported by trial data and consistent with NICE and BTS/SIGN asthma management.