Fluticasone inhalers

Inhaled fluticasone is a medicine used for asthma and chronic obstructive pulmonary disease (COPD).

You can take it using an inhaler (sometimes called a "puffer") which is available as an Evohaler or an Accuhaler. It's usually brown, orange or beige. This is called a preventer inhaler because it helps to prevent you from getting symptoms.

If you have severe asthma or COPD, you may need to use a nebuliser. A nebuliser is a machine that helps you breathe in your medicine as a mist, using a mask or a mouthpiece. You can use a nebuliser in hospital, or you may be given one to manage your condition at home. Fluticasone nebuliser liquid comes in individual doses called nebules.

Fluticasone inhalers and nebules are available on prescription.

Some inhalers contain fluticasone mixed with other medicines that help your breathing. Brand names include Flutiform, Relvar, Seretide and Trelegy.

Fluticasone is a type of medicine known as a steroid (also called a corticosteroid). This is not the same as an anabolic steroid.

It also comes as:

• a skin cream, for skin conditions such as eczema
• a nasal spray or nasal drops, for hay fever and cold-like symptoms caused by common allergies (allergic rhinitis), and nasal polyps

Most adults and children aged 4 years and over can use fluticasone inhalers.

Most adults can use fluticasone in a nebuliser.

Children aged under 18 years old can use fluticasone in a nebuliser only if it's with advice from a specialist doctor. This is because children need to be monitored to make sure their condition is not getting worse.

Fluticasone is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to fluticasone or any other medicine
• are pregnant, or trying to get pregnant – your doctor may want to lower your dose
• are being treated for viral or fungal infections
• are taking or have recently taken other steroid medicines
• have ever had tuberculosis (TB)

The usual dose for the fluticasone inhaler is 1 or 2 puffs, taken twice a day.

It's important to use your fluticasone inhaler or nebuliser regularly to manage your symptoms. Use it regularly, even if you do not have any symptoms.

After using your inhaler, always put the lid back on to keep it clean.

Fluticasone inhalers come in different strengths. Your doctor, asthma nurse or respiratory nurse will tell you which strength is right for you. Always follow their instructions. They may tell you to have more than 2 puffs at a time from your inhaler. It depends on how bad your breathing is and which inhaler you're using.

The usual dose for the nebuliser is 0.5mg to 2mg, breathed in from the nebuliser machine, twice a day.

Fluticasone nebules come in different strengths. Your doctor or nurse will give you clear instructions on how to use the nebuliser.

Your dose may go up or down depending on how bad your breathing is. You'll be prescribed the lowest dose that controls your symptoms.

If you've agreed on a personal action plan with your doctor or nurse, follow your action plan.

There are different types of fluticasone inhaler. It's very important to use your inhaler properly. This is so you get the right amount of fluticasone into your lungs and the most benefit from your medicine.

Before using your inhaler, read the information leaflet that comes with it. This leaflet contains instructions and diagrams to show you how to use the inhaler, how to keep it clean, and how long to use it before getting a replacement.

Watch a video

Asthma + Lung UK has some short videos showing you how to use your inhaler to help you manage your symptoms. You can search by type of inhaler and by brand (such as Flixotide).

If you use a pressurised metered-dose inhaler (pMDI), for example, you can watch the pMDI video.

To get the most from your inhaler, it's important to have your technique checked regularly.

If you are not sure how to use your inhaler, or your technique has not been checked for a year, ask your doctor, nurse or a pharmacist to watch you use it.

It's very important to use your inhaler properly. This is so you get the right amount of fluticasone into your lungs and the most benefit from your medicine.

Remove the mouthpiece cover completely before using your inhaler. Check the inside and outside of the mouthpiece to make sure it's clean and there's nothing inside it. Shake the inhaler 4 or 5 times to remove any loose objects.

After use, replace the mouthpiece cover straight away. Firmly push it and make sure it clicks into place.

If you or your child find it difficult to use an inhaler, your doctor or nurse may give you a spacer to use with it.

A spacer is a large plastic container with a mouthpiece and a hole for the inhaler. When used with the inhaler it makes it easier to get the right amount of fluticasone into your lungs.

Spacers can reduce the risk of side effects from the medicine affecting your mouth and throat. They're particularly useful for giving fluticasone to young children.

Your doctor, nurse or a pharmacist can show you how to use a spacer with your inhaler.

You'll usually use fluticasone for a long time. It helps prevent your asthma or COPD getting worse.

It's important to keep using your inhaler or nebuliser even if you feel better.

Do not stop using fluticasone suddenly, even if you feel better, without speaking to your doctor or nurse first.

If you have an inhaler or nebuliser to control asthma or COPD, your breathing problems may return if you suddenly stop using it.

If you forget a dose, use your inhaler or nebuliser as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Taking more than your prescribed dose of fluticasone is unlikely to harm you.

If you're worried, talk to your doctor or a pharmacist.

If you take more than 400 micrograms of fluticasone a day (for example, if your dose is 250 micrograms, twice a day), ask your doctor, nurse or a pharmacist if you need to carry a blue steroid treatment card, a red steroid emergency card, or both.

If you need any medical or dental treatment, show your blue or red steroid card to the doctor, dentist or pharmacist so they know that you're taking fluticasone.

These common side effects of inhaled fluticasone may happen in more than 1 in 100 people. There are things you can do to help cope with them:

Try rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening.

Ask a pharmacist to recommend a suitable treatment for oral thrush, such as a mouth gel or liquid, and get them to check that you're using your inhaler correctly. They may suggest that you see your doctor to discuss the best treatment.

Try rinsing your mouth with water or brushing your teeth after using your inhaler to stop this happening. Using a spacer with your inhaler can also help.

Keep taking the medicine but talk to your doctor if these side effects bother you or do not go away.

It's unusual to have any serious side effects when using a fluticasone inhaler.

You are more likely to get serious side effects if you're taking a high dose of fluticasone for a long time (more than a few months).

Speak to a doctor if you get "moon face" (a puffy, rounded face), and weight gain in your upper back or belly – this happens gradually and can be a sign of Cushing's syndrome.

Call a doctor or call 111 now if you get:

• a high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm) or a change in colour of your mucus, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
• a very upset stomach or you're being sick (vomiting), very bad dizziness or passing out, muscle weakness, very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
• changes in your eyesight, such as blurred vision, as this can be a sign of increased pressure in your eyes (glaucoma) or central serous chorioretinopathy (accumulation of fluid in the eye), or a cloudy lens in your eye, which could be a sign of a cataract

Serious allergic reaction

It happens rarely but it's possible to have a serious allergic reaction (anaphylaxis) to fluticasone.

This is different to an asthma attack. If you or your child have asthma symptoms, such as wheezing or have tightness in the chest or throat, use a reliever inhaler as advised for an asthma attack. If the symptoms do not improve or get worse, call 999 or go to A&E.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Taking fluticasone at high doses for a long time can slow down the normal growth of children and teenagers.

Your child's doctor will monitor their height and weight carefully for as long as they're taking this medicine. This will help them to know if your child's growth is slowing down and change the treatment if needed.

Even if your child's growth does slow down, this does not seem to have much effect on their adult height.

Talk to your doctor if you're worried. They'll be able to explain the benefits and risks of giving your child fluticasone.

These are not all the side effects of fluticasone. For a full list see the leaflet inside your medicines packet.

It's important to manage your asthma or chronic obstructive pulmonary disease (COPD) while you're pregnant. Having difficulty with breathing during pregnancy can be dangerous for you and your baby.

You can use a fluticasone inhaler in pregnancy. Because it goes straight into your lungs, very little gets into your bloodstream and to your baby. Even if a small amount reaches your baby, there is no evidence that it will cause harm.

Do not stop using your inhaler if you become pregnant while using fluticasone. Talk to your doctor if you have any concerns or problems with your asthma or COPD and your medicine.

It's OK to use your fluticasone inhaler as normal while you're breastfeeding.

It is not known how much fluticasone gets into breast milk, but it's likely to be a tiny amount. Your baby will not absorb a lot of fluticasone into their body from the breast milk. It's very unlikely to cause any side effects in your baby.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

There's no evidence that using a fluticasone inhaler will affect fertility in either men or women.

Some medicines and fluticasone affect each other. This can increase your chance of side effects, or it may mean changing your dose of fluticasone.

Check with a pharmacist or your doctor if you're taking:

• medicines used to treat HIV, such as ritonavir or cobicistat
• medicines to treat fungal infections, such as ketoconazole or itraconazole
• other medicines that contain steroids, such as eczema creams, other asthma inhalers, steroid tablets, injections, nasal sprays, eye or nose drops

These medicines can increase the chances of side effects in the rest of your body.

There is not enough information to say that complementary medicines and herbal remedies are safe to take with fluticasone. They are not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.