Fluticasone with salmeterol

How it works

Fluticasone propionate provides anti-inflammatory corticosteroid action, while salmeterol gives prolonged bronchodilation by stimulating beta2 adrenoceptors; salmeterol has a slow onset and is unsuitable for acute relief.

Prescribing in practice

• Salmeterol has a slow onset and must never be used to treat an acute asthma attack, and the long-acting beta2 agonist must always be paired with the inhaled corticosteroid.
• Inhaled corticosteroid use raises pneumonia risk in COPD and can cause oral candidiasis and dysphonia.
• Beta2 agonist effects include tremor, palpitations and hypokalaemia, warranting caution in cardiovascular disease.

Monitoring

Review symptom control and inhaler technique, monitor for pneumonia in COPD, oral thrush, and growth in children on long-term therapy.

Counselling the patient

• Use regularly as a preventer; it will not relieve sudden breathlessness.
• Rinse the mouth after each dose to reduce thrush and hoarseness.
• Always carry a fast-acting reliever and seek help if symptoms worsen.

Evidence & guidelines

A long-established inhaled corticosteroid/long-acting beta2 agonist combination supported by large asthma and COPD trials and embedded in UK respiratory guidance.