Fluticasone/Salmeterol as Home Medication for COPD/Asthma Discharge
Yes, fluticasone salmeterol can be prescribed as a home medication for a patient with COPD or asthma being discharged, typically for long-term maintenance therapy with regular follow-up every 4-6 weeks initially. 1, 2
Appropriate Use and Duration
For COPD Patients:
- Fluticasone/salmeterol 250/50 mcg twice daily is the recommended dosage for COPD maintenance therapy 2
- Long-term use is appropriate as maintenance therapy to:
- Reduce exacerbations
- Improve lung function
- Maintain airflow
- Reduce symptoms
For Asthma Patients:
- Dosing depends on severity:
- Ages 12+ years: 100/50,250/50, or 500/50 mcg twice daily
- Ages 4-11 years: 100/50 mcg twice daily 2
- Continued as maintenance therapy with regular follow-up
Discharge Planning Considerations
When discharging a patient on fluticasone/salmeterol:
Ensure proper inhaler technique:
- Verify patient can use the device effectively before discharge
- The inhaled route is preferable, but ensure the patient has a device they can use properly 1
Provide sufficient medication:
- Supply enough medication to last until the next opportunity for consultation with their GP 1
Patient education:
- Explain treatment regimen clearly
- Ensure patient/caregiver understands medication use and delivery device 1
Follow-up arrangements:
- Schedule GP follow-up within 1 week
- Arrange specialist follow-up within 4 weeks 1
Monitoring and Follow-up
After discharge, patients should have:
- PEF monitoring (if appropriate)
- Assessment of symptoms
- Review of inhaler technique at follow-up visits
- Evaluation for potential dose reduction if stable 3
Important Considerations and Cautions
Contraindications:
- Severe hypersensitivity to milk proteins (fluticasone/salmeterol DPIs contain lactose) 2
- Primary treatment of status asthmaticus or acute episodes requiring intensive measures 2
Common Side Effects to Monitor:
- COPD: Pneumonia, oral candidiasis, throat irritation, dysphonia, viral respiratory infections 2
- Asthma: Upper respiratory tract infection, pharyngitis, dysphonia, oral candidiasis 2
Special Precautions:
- For patients with milk allergy, consider metered-dose inhalers (MDIs) as they typically don't contain lactose 4
- Advise patients to rinse mouth after use to reduce risk of oral candidiasis 2
- Monitor for signs of pneumonia in COPD patients 2
Efficacy Evidence
Studies have demonstrated that:
- Combination therapy with fluticasone/salmeterol provides better lung function improvement than either component alone 5
- In COPD, significant improvements in FEV₁ are observed after 3 months of treatment 5
- For asthma patients, the combination allows for better symptom control and potentially lower steroid doses 6, 3
By following these guidelines, you can safely prescribe fluticasone/salmeterol as a home medication for your patient being discharged, ensuring appropriate treatment continuation and follow-up.