The updates have introduced an Initial Maintenance Therapy section under the heading Posology and Method of Administration. These products may now be used in patients with moderate persistent asthma defined as:
- Daily symptoms
- Daily use of reliever inhalers
- Moderate to severe airflow obstruction (FEV1 or PEF 60-80% predicted normal)
If all three of the above are present a combination product delivering a twice-daily dose of 100 micrograms of fluticasone and 50 micrograms of salmeterol can be used for initial treatment. This is equivalent to two doses twice a day of the pMDI and one dose twice a day of the DPI. If any of the criteria above are not present a standard inhaled corticosteroid, for example beclometasone, should be used for initial treatment.
Once control is attained with the approach outlined above treatment should be reviewed and consideration given to stepping down to an inhaled corticosteroid alone in place of the combination product.
Action: Healthcare professionals should be aware of this change. This combination can be used to rapidly control asthma in suitable patients but treatment should be reviewed and stepped down once control is achieved.