Dosage of Salmeterol Fluticasone MDI in the Elderly
The recommended dose of salmeterol/fluticasone MDI for elderly patients is the same as for other adults: typically 2 inhalations twice daily, with the specific strength depending on asthma severity or level of control. 1
Dosing Guidelines for Salmeterol/Fluticasone
General Adult Dosing (Including Elderly)
- Salmeterol/fluticasone combination is administered twice daily (bid), with dosage depending on the severity of asthma or level of control 1
- The standard adult dose of salmeterol is 50 mcg every 12 hours 1
- For fluticasone component, dosing ranges from low to high based on asthma severity 1:
- Low dose: 88-264 mcg/day
- Medium dose: >264-440 mcg/day
- High dose: >440 mcg/day
Special Considerations for Elderly
- No specific dose adjustment is required based on age alone 1
- Elderly patients may be more susceptible to side effects such as tremor from salmeterol and systemic effects of fluticasone 1
- Caution is advised in elderly patients with ischemic heart disease, as beta agonists may require ECG monitoring with the first dose 1
Formulation Strengths Available
- Fluticasone/salmeterol MDI is available in different strengths 1:
- 44/21 mcg per puff
- 110/21 mcg per puff
- 220/21 mcg per puff
Administration Technique
- Shake the inhaler well before each use 2
- Exhale fully before placing the mouthpiece between lips
- Inhale deeply and slowly while pressing down on the canister
- Hold breath for 10 seconds if possible
- Wait at least 30 seconds before taking the second puff 2
- Using a spacer device can increase medication delivery, especially important for elderly patients who may have coordination difficulties 1
Potential Adverse Effects
- Common side effects include oral candidiasis, hoarseness/dysphonia, throat irritation, and headache 3
- Elderly patients have a higher risk of pneumonia when using fluticasone-containing inhalers (9% in patients >65 years vs. 4% in younger patients) 3
- Salmeterol may cause tachycardia, skeletal muscle tremor, and hypokalemia 1
Clinical Pearls for Elderly Patients
- Assess cognitive function and physical ability to use the MDI properly; consider alternative delivery devices if coordination is poor 1
- Regular monitoring for adverse effects is important, especially for pneumonia risk 3
- Elderly patients with comorbidities such as cardiovascular disease require closer monitoring 1
- The combination of salmeterol/fluticasone has been shown to reduce exacerbations in COPD patients, which is particularly important for elderly patients 4, 5
Common Pitfalls to Avoid
- Failing to assess proper inhaler technique, which is especially important in elderly patients who may have coordination difficulties 1
- Not using a spacer device when appropriate, which can improve drug delivery and reduce local side effects 1
- Overlooking increased pneumonia risk in elderly patients using fluticasone-containing inhalers 3
- Not monitoring for potential drug interactions with other medications commonly used by elderly patients 6