What is the dosage frequency of Zenhale (mometasone/formoterol) for a 37-year-old woman with uncontrolled asthma, previously on Ventolin (albuterol) and Flovent (fluticasone), during and after a cold?

Management of Zenhale (Mometasone/Formoterol) for Uncontrolled Asthma During and After a Cold

For this 37-year-old woman with uncontrolled asthma, Zenhale (mometasone/formoterol) should be taken as two inhalations twice daily during a cold, and then continued at two inhalations twice daily as maintenance therapy with reassessment in 2-4 weeks after starting treatment.

Dosing During a Cold

When experiencing a cold, patients with asthma often have worsening symptoms that can trigger exacerbations. For this patient with uncontrolled asthma (daily symptoms, frequent wheeze, multiple uses of Ventolin):

• During a cold: Maintain Zenhale at two inhalations twice daily (morning and evening) 1
• Continue to use Ventolin (albuterol) as needed for breakthrough symptoms
• If symptoms worsen significantly during the cold, a short course of oral corticosteroids may be considered 1
• The combination of inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) in Zenhale helps reduce cold-related exacerbations by up to 36% compared to other regimens 2

Maintenance Dosing After the Cold

After the cold resolves:

• Continue Zenhale at two inhalations twice daily 3
• This dosing is appropriate for a patient with uncontrolled symptoms who was previously on Flovent (fluticasone) and is now requiring step-up therapy
• The mometasone component provides anti-inflammatory effects while formoterol provides both immediate and long-acting bronchodilation

Timing of Reassessment

• Reassess the patient in 2-4 weeks after starting Zenhale therapy 1, 3
• At this follow-up visit, evaluate:
  • Symptom control (frequency of daytime and nighttime symptoms)
  • Frequency of rescue medication use
  • Lung function (PEF or spirometry if available)
  • Proper inhaler technique
  • Medication adherence
  • Any side effects

Monitoring and Adjustments

• If symptoms are well-controlled after 3 months of therapy, consider stepping down by reducing to one inhalation twice daily 1
• If symptoms remain uncontrolled at the 2-4 week follow-up, consider:
  1. Checking inhaler technique
  2. Assessing adherence
  3. Identifying potential triggers
  4. Adding additional controller medication
  5. Referral to a specialist if symptoms remain poorly controlled 3

Important Considerations

• Mometasone/formoterol provides both maintenance and quick relief due to the rapid onset of formoterol 4
• Evening dosing of mometasone has been shown to be particularly effective for controlling nocturnal symptoms 5
• Patients should rinse their mouth after using Zenhale to prevent oral candidiasis 3
• Formoterol should never be used alone for asthma management due to increased risk of asthma-related death 6

Patient Education

• Instruct the patient on proper inhaler technique
• Create a written asthma action plan that includes what to do during a cold or exacerbation
• Emphasize the importance of taking the medication regularly, even when feeling well
• Explain that the medication contains both a controller (mometasone) and a bronchodilator (formoterol)
• Advise that improvement may be seen within days, but optimal benefit may take 1-2 weeks

This approach provides optimal control of asthma symptoms while minimizing the risk of exacerbations, particularly during respiratory infections, which are common triggers for this patient.