What is the recommended dosage and usage of Seretide (Fluticasone/Salmeterol) for asthma or Chronic Obstructive Pulmonary Disease (COPD)?

Seretide (Fluticasone/Salmeterol) Dosing and Usage

Recommended Dosage for Asthma

For adults and adolescents ≥12 years with asthma: administer 1 inhalation of Seretide twice daily, with starting strength (100/50,250/50, or 500/50 mcg) determined by asthma severity. 1

• For children aged 4-11 years: 1 inhalation of Seretide 100/50 mcg twice daily 1
• Seretide 50/250 mcg twice daily provides superior efficacy compared to fluticasone propionate 250 mcg alone in patients with moderate persistent asthma, demonstrating a 21 L/min greater improvement in morning peak expiratory flow 2
• Initial maintenance treatment with Seretide is appropriate for moderate-to-severe persistent asthma, offering improved lung function, symptom control, and reduced exacerbation rates compared to monotherapy 3, 2

Recommended Dosage for COPD

For maintenance treatment of COPD: administer 1 inhalation of Seretide 250/50 mcg twice daily. 1

• This combination is specifically indicated for patients with severe COPD (FEV1 <50-60% predicted) and a history of repeated exacerbations 4, 5
• Seretide should be reserved for COPD patients with ≥2 exacerbations per year requiring antibiotics or oral steroids, as recommended by GOLD guidelines 4
• The combination reduces exacerbation frequency and improves health-related quality of life compared to component monotherapies or placebo 6

Critical Safety Warnings

Long-acting beta-agonist (LABA) monotherapy increases the risk of serious asthma-related events; Seretide must never be used as monotherapy for asthma. 1

• Do not use Seretide for relief of acute bronchospasm - it is not indicated for acute symptoms in either asthma or COPD 1
• Do not combine Seretide with additional LABA-containing medications due to overdose risk 1
• Inhaled corticosteroid-containing regimens increase pneumonia risk by approximately 4% in COPD patients - monitor for signs and symptoms of pneumonia 4
• Contraindicated in patients with severe hypersensitivity to milk proteins or any component of the formulation 1

Administration Technique

Administer via oral inhalation only using the dry powder inhaler device (Diskus/Accuhaler). 1

• Over 99% of patients with asthma or COPD can generate sufficient inspiratory flow (≥30 L/min) through the device for effective dose delivery, regardless of age or severity of airflow obstruction 7
• Advise patients to rinse mouth with water without swallowing after each inhalation to reduce risk of oral candidiasis 1

When NOT to Use Seretide

Avoid Seretide in COPD patients without frequent exacerbations (<2 per year) and FEV1 >50% predicted - these patients do not benefit from the added corticosteroid component and face unnecessary pneumonia risk 4

• Do not use as primary treatment for status asthmaticus or acute episodes requiring intensive measures 1
• Discontinue in patients with recurrent pneumonia or high pneumonia risk who are not experiencing frequent exacerbations 4

Monitoring Requirements

• Monitor for oral candidiasis periodically during treatment 1
• Assess bone mineral density initially and periodically, particularly with long-term use 1
• Monitor growth in pediatric patients receiving prolonged treatment 1
• Consider ophthalmology referral for patients developing ocular symptoms or using long-term, as glaucoma and cataracts may occur 1
• Evaluate for systemic corticosteroid effects with high dosages, including hypercorticism and adrenal suppression 1

Escalation Strategy

For COPD patients with persistent symptoms or exacerbations despite Seretide 250/50 mcg twice daily, add a long-acting muscarinic antagonist (LAMA) for triple therapy. 4

• Triple therapy (ICS/LABA/LAMA) is recommended for GOLD category D patients with severe COPD 4
• This stepwise approach targets patients with the highest symptom burden and exacerbation risk 4