Can a patient who previously used Seretide (fluticasone + salmeterol) as maintenance therapy for asthma or COPD restart it after stopping, and how should the dose be re‑initiated?

Restarting Seretide After Discontinuation

Yes, a patient can restart Seretide (fluticasone/salmeterol) after stopping, and should resume at the same maintenance dose they were previously using if it was providing adequate control, without requiring a gradual titration period. 1, 2

Direct Restart Protocol

Resume the previously effective maintenance dose immediately – there is no need for dose escalation or "re-titration" when restarting Seretide after a treatment gap. 1, 2

• If the patient was previously controlled on Seretide 250/50 mcg twice daily, restart at that exact dose 2, 3
• If the patient was on Seretide 500/50 mcg twice daily, restart at that dose 2, 4
• The combination formulation provides both the long-acting beta-agonist (salmeterol 50 mcg) and inhaled corticosteroid (fluticasone 250 or 500 mcg) in fixed doses 5, 3

Critical Safety Considerations When Restarting

Never allow the patient to use salmeterol (the LABA component) as monotherapy – LABAs must always be combined with inhaled corticosteroids due to increased risk of severe exacerbations and asthma-related deaths when used alone. 1, 6

• Seretide combination products inherently prevent this risk by providing both components together 5, 3
• Ensure the patient understands Seretide is a maintenance therapy only, not a rescue inhaler 1, 5
• The patient must have a separate short-acting beta-agonist (salbutamol/albuterol) for acute symptom relief 7

Proper Administration Technique

Verify correct inhaler technique before the first dose to ensure adequate drug delivery and prevent treatment failure that mimics inadequate dosing. 1

• For Diskus/Accuhaler dry powder formulation: demonstrate proper technique at restart 5, 3
• Rinse mouth immediately after each use (at least twice, then spit) to prevent oral candidiasis and dysphonia 1
• If using MDI formulation, always use with a spacer device to enhance lung deposition 1

Reassessment Timeline After Restart

Evaluate asthma/COPD control at 2–6 weeks after restarting therapy to confirm the previous dose remains appropriate. 1

• Assess frequency of daytime symptoms, nighttime awakenings, rescue inhaler use, and activity limitations 1
• If control is inadequate after 4–6 weeks despite proper technique and adherence, consider stepping up therapy rather than assuming the previous dose is still sufficient 1
• If the patient stopped due to perceived lack of benefit, investigate whether poor inhaler technique or non-adherence was the actual issue 1

Common Pitfalls to Avoid

Do not start at a lower "introductory" dose – this delays achieving therapeutic effect and is unnecessary for patients restarting a previously tolerated regimen. 2, 3

• Patients with COPD in clinical trials started directly at maintenance doses (250/50 or 500/50 mcg twice daily) without titration 2, 8
• The combination must be used daily as controller medication, not intermittently during exacerbations 1

Do not increase the inhaled corticosteroid dose during acute exacerbations – instead, add systemic oral corticosteroids (prednisolone 30–40 mg daily) if needed. 7, 1

• Continue Seretide at the maintenance dose throughout any exacerbation 1
• Nebulized bronchodilators can be added for acute relief without stopping Seretide 7

Duration of Treatment

Plan for at least 3 months of continuous therapy before assessing full therapeutic benefit, particularly in COPD patients. 8

• Gradual improvements in lung function occur over weeks to months 8, 4
• After achieving sustained control for 2–4 months, consider stepping down to the minimum effective dose 1

When Restarting May Not Be Appropriate

Reassess the original indication if the patient stopped due to side effects or lack of efficacy:

• If the patient experienced significant corticosteroid-related adverse effects (oral thrush, dysphonia, adrenal suppression), verify proper technique was used and consider alternative ICS/LABA combinations 1, 3
• If the patient has frequent exacerbations despite previous Seretide use, specialist evaluation may be needed to optimize therapy 7, 4
• Withdrawal from fluticasone-containing products requires careful management to minimize exacerbations if switching to alternative therapy 3