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Fluticasone inhaler for asthma prevention (prophylaxis)

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Fluticasone inhaler for asthma prevention (prophylaxis)

This leaflet is about the use of fluticasone for the treatment of asthma. It is taken regularly to prevent attacks. (This is sometimes called asthma prophylaxis.)

Information Standard quality markThis leaflet has been written specifically about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Fluticasone inhalers should not be used during an acute asthma attack (sudden onset of wheezing and breathlessness). Use your child’s reliever medicine (usually a blue salbutamol inhaler).

Name of drug

Fluticasone
Brand names:
Flixotide®

Why is it important for my child to take this medicine?

Fluticasone is a steroid medicine. It reduces inflammation in the lungs that can act as a trigger for an asthma attack, and so should reduce the number of attacks. Fluticasone is commonly called a ‘preventer’ medicine. It is important that your child takes it regularly to help prevent asthma attacks.

Fluticasone will not reduce wheezing or breathlessness during an acute asthma attack – your child should use their ‘reliever’ inhaler for this (this is often a blue salbutamol inhaler).

What is fluticasone available as?

Fluticasone has to be inhaled into the lungs (breathed in) to work. A special device called an inhaler is used and this is usually used with another device called a spacer. Dry powder inhalers are sometimes used for older children.

Inhalers that contain only fluticasone are orange:

  • Accuhaler®: 50 micrograms per inhalation (puff)
  • Diskhaler®: 100 micrograms per inhalation
  • Evohaler® metered dose inhaler: 50 micrograms or 125 micrograms per inhalation

Your doctor may suggest that your child uses an inhaler that provides fluticasone together with another medicine called salmeterol, which has the brand name Seretide®. Inhalers that contain both these medicines are called Seretide Accuhaler® and Seretide Evohaler® – these inhalers are purple.

When should I give fluticasone?

Fluticasone is usually given twice each day, once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example some time between 7 and
8 am, and between 7 and 8 pm.

Give the medicine at about the same times each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of fluticasone (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it?

Your doctor or asthma nurse will show you how to use the inhaler and the spacer device, if one is needed.

This section provides instructions on how to use the fluticasone inhalers. An instruction leaflet will also be provided with the inhaler. This will tell you how to put the inhaler together and how to use it.

If you are not sure whether you are using the inhaler properly, or need help, contact your asthma nurse or pharmacist, who will be able to show you or check what you are doing.

Inhalers work best when used with your child standing, as the medicine is more likely to get into the lungs. You may find it easier to sit a younger child on your lap. A face mask can be used instead of a mouthpiece for younger children.

Using the Accuhaler or Dischaler (these do not need a spacer device)

Follow the instructions that come with your inhaler for how to get it ready. If you are not sure how to do this, ask your pharmacist or asthma nurse to show you.

  • Ask your child to breathe out normally, as far as they can. Place the mouthpiece of the inhaler firmly between the lips, ensuring a good seal around the mouthpiece.
  • Once they have started to breathe in, press down once on the canister with the first finger. Your child should continue to finish the breath in, so that they inhale the puff of medicine.
  • Take the inhaler out of your child’s mouth. They should close their mouth and hold their breath for 5–10 seconds, or for as long as they can comfortably manage. They can then breathe normally. It is important not to rush this step.
  • If your child has to take more than one puff, they should breathe normally for a minute or so before giving the next one.
  • Your child should rinse their mouth out thoroughly with water or clean their teeth.
Using the Evohaler aerosol inhaler with a ‘spacer’ device
  • Put the spacer device together, following the instructions that come with it.
  • For a young child, attach the mask to the spacer mouthpiece. If your child can hold the spacer mouthpiece in their mouth and hold it firmly between their lips, creating a good seal, you may not need to use the mask.
  • Take the cap off the inhaler, making sure that the mouthpiece is clean.
  • While holding the inhaler upright, place your thumb on the bottom of the inhaler and your first finger on the top. Then shake the inhaler several times up and down.
  • If the inhaler is new or has not been used for three days or more, one puff should be released into the air.
  • Insert the mouthpiece of the inhaler into the spacer. It should fit easily and securely.
  • Place the face mask over the child’s mouth and nose, ensuring a good seal with the skin around the mouth. Reassure your child during this step, as they may be distressed.
  • Press down once on the aerosol canister with the first finger. This releases one puff into the spacer.
  • Hold the mask in place and encourage your child to take five deep and slow breaths in and out. It is important not to rush this step.
  • If more than one dose/puff is required, wait for one minute then repeat the previous steps.
  • Your child should rinse their mouth out thoroughly with water or clean their teeth.

When should the medicine start working?

Fluticasone needs to be given regularly to prevent asthma and wheeze. It will start to work within 24 hours, but it may take a few weeks to reduce the inflammation. Your child may continue to have attacks during this time, but they should start to happen less often. Continue to give the medicine as told to by your doctor or nurse, even if your child does not have any wheeze or other symptoms of asthma. 

If your child’s asthma does not seem to be getting any better and they still need to use their reliever medicine often, contact your doctor or asthma nurse.

What if my child is sick (vomits)?

If your child is sick at any time, you do not need to give them another dose, as the inhaled medicine will still work.

What if I forget to give it?

If you remember up to 4 hours after you should have given a dose, give your child the missed dose. For example, if you usually give a dose at about 7 am, you can give the missed dose at any time up to 11 am. If you remember after that time, do not give the missed dose. Wait until the next normal dose.

What if I give too much?

Fluticasone is unlikely to cause any harm if your child accidently has more puffs than your doctor has recommended.

If you are worried that you may have given your child too much, contact your doctor or local NHS services (111 in parts of England; 0845 4647 in parts of England and Wales; 08454 24 24 in Scotland) for advice. Have the inhaler or packaging with you if you telephone for advice.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

If your child is taking a high dose of fluticasone, they may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice, as this may need treatment. You can help prevent this by making sure that your child rinses their mouth after using fluticasone, and by using a spacer device.

  • If your child’s voice is hoarse or their throat is sore after using the inhaler, encourage them to rinse their mouth after every use.
  • Your child may develop a dry mouth with this medicine. Eating citrus fruits (e.g. oranges) or taking sips of water may help.
  • Inhaled fluticasone may slow the rate at which your child grows at the start of treatment, they will probably catch up when their asthma is properly controlled. Their final adult height should not be affected. Your doctor should monitor the growth of your child while they are receiving treatment with fluticasone.
  • All steroid medicines, including fluticasone, but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery.

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side-effects to a UK safety scheme at yellowcard.mhra.gov.uk.

Can other medicines be given at the same time as fluticasone?

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
  • Fluticasone should not be taken with some medicines that you get on prescription. Tell your doctor and pharmacist about any other medicines your child is taking before giving fluticasone.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Is there anything else I need to know about this medicine?

If your child becomes very unwell or requires an operation, tell the doctors that your child uses a fluticasone inhaler.

In a very few cases, children become unwell when they stop or reduce the amount of any steroid medicine they are taking, including fluticasone (in high doses). This may include your child becoming very tired or dizzy, having stomach  pains or vomiting. If you are at all worried about this, contact your doctor.

  • Your child should rinse their mouth out thoroughly with water or clean their teeth after using the inhaler.
  • Clean the spacer at least once a month in warm soapy water and leave it to drip dry. This will prevent medicine residue from building up on the inside of the device. Do not use a cloth to dry the spacer, as this will cause the build up of static, and it may not work properly.

General advice about medicines

  • Try to give medicines at about the same times each day, to help you remember.
  • If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses, as you may do harm.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where I should keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information

Your doctor, pharmacist or nurse will be able to give you more information about fluticasone and about other medicines used to treat asthma.

You can also get useful information from: 
Publication date: 
31/01/2012

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