Dulera Must Be Taken Daily as Scheduled Maintenance Therapy
Dulera (mometasone furoate/formoterol) must be taken twice daily every day as a controller medication, not as needed for symptom relief. This is a fundamental principle of combination inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) therapy for asthma management.
Why Daily Dosing Is Required
Combination ICS/LABA inhalers like Dulera are maintenance medications designed to prevent symptoms and exacerbations, not to treat acute symptoms. The evidence supporting this approach is clear:
Long-acting beta-agonists (LABAs) should never be used as monotherapy or on an as-needed basis for asthma control, as they must always be combined with regular inhaled corticosteroid therapy to reduce the risk of severe exacerbations and asthma-related deaths 1
Inhaled corticosteroids are effective when administered on a twice-daily basis as regular maintenance therapy, providing sustained anti-inflammatory control 1
The combination of ICS/LABA taken regularly provides superior symptom control and lung function compared to either component alone or increased doses of ICS alone 2, 3
Proper Use of Dulera
Dulera should be administered as two inhalations twice daily (morning and evening), approximately 12 hours apart:
The regular twice-daily dosing maintains consistent bronchodilation and anti-inflammatory effects throughout the 24-hour period 4
Once-daily dosing of ICS/LABA combinations does not maintain lung function improvements for the full 24 hours compared to twice-daily administration, making it less effective 4
Studies demonstrate that twice-daily ICS/LABA therapy provides better efficacy than higher-strength once-daily dosing 4
Critical Safety Considerations
Never use Dulera or any ICS/LABA combination as a rescue inhaler for acute symptoms:
Short-acting beta-agonists (like albuterol) should be used on an as-needed basis for acute symptom relief, not long-acting combinations 1
Using short-acting beta-agonists more than 2-3 times per day indicates inadequate asthma control and suggests the need to step up maintenance therapy 1
The FDA has issued warnings about increased severe exacerbations and deaths when LABAs are used improperly, emphasizing they must only be used in combination with inhaled corticosteroids as regular maintenance therapy 1
Monitoring Treatment Response
Regular compliance with twice-daily dosing should be verified, especially if symptom control remains poor:
Compliance with treatment is critical and should be checked regularly before considering treatment escalation 1
Proper inhaler technique must be ensured, as inadequate technique is a common cause of treatment failure 5
If patients require rescue medication more than twice weekly, this indicates inadequate control and warrants reassessment of the maintenance regimen 1