Medicines

Salmeterol inhaler for asthma

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

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

Do not use salmeterol without a steroid inhaler that acts as a preventer.

Name of medicine

Salmeterol (sal-MEE-ter-ol)

Brand name: Serevent®

This leaflet is about the use of inhaled salmeterol for the treatment of asthma. It is taken regularly along with an inhaled steroid to prevent asthma attacks.

Why is it important for my child to take salmeterol?

Salmeterol is used to help prevent asthma attacks and wheeze. Your doctor will probably recommend that you continue to give your child inhaled steroids. It is important that your child takes it regularly to help prevent asthma attacks.  

salmeterol 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 salmeterol available as?

Salmeterol 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.

  • Evohaler®: 25 micrograms per inhalation (puff)
  • Accuhaler®: disk containing 60 blisters of 50 micrograms salmeterol

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

Seretide® and Serevent® are licensed for use in children who are 4 years and older.

When should I give salmeterol

Salmeterol 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 salmeterol (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 salmeterol?

Using an aerosol inhaler with a ‘spacer’ device

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

  • Put the spacer device together, following the instructions that come with it. Attach the mask to the spacer mouth piece.
  • For a young child, attach the mask to the spacer mouth piece. If your child can hold the spacer mouth piece 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 mouth piece 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 mouth piece of the inhaler into the spacer. It should fit easily and securely.
  • Place the mask over your 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 after use.

Using a dry-powder inhaler

There are many different types of dry-powder inhaler. These are not used with a spacer.

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 nurse to show you. The following instructions are for most dry-powder inhalers:

  • 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, give (release) the dose as directed by your pharmacist or nurse. 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 after use.

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.

When should the medicine start working?

Salmeterol needs to be given regularly with your child’s steroid medicine to help prevent asthma and wheeze. It does not work straight away but your child should start to wheeze less and to need less reliever medicine within a week after starting treatment. Continue to give the medicine as told to by your doctor or nurse, even if your child does not have any wheeze or 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 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 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.

Never give a double dose of salmeterol, unless your doctor has told you to.

What if I give too much?

You are unlikely to do harm if you give an extra dose of salmeterol by mistake. If you are concerned that you may have given too much, contact your doctor or local NHS services (111 England and Scotland; 111 or 0845 4647 in parts of Wales) or take your child to hospital.

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).

Side effects you must do something about

If your child has an irregular or fast heart beat (they may say their heart feels fluttery or is racing), contact your doctor straight away.

Other side-effects you need to know about

Your child may get some of the following side-effects when they first start taking salmeterol. They are usually mild and should wear off after a few days as your child’s body gets used to the medicine. If the side effects are still a problem after 2 weeks or you are worried, contact your doctor but continue to give salmeterol.

  • Your child may feel dizzy or light-headed when they stand up, or may even faint. Encourage them to stand up slowly, and to sit or lie down if they feel dizzy or lightheaded.

  • Your child may get headaches, have mild tremor (shakiness), especially in the hands, or have joint or muscle pain or cramps.

  • Some children may become more nervous or anxious than usual, and they may have disturbed sleep. If this happens, give the medicine earlier in the evening.

  • Your child may feel sick or be sick (vomit). If this is still a problem after a week, contact your doctor.

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 www.mhra.gov.uk/yellowcard

More information on side-effects can be found in the following leaflet http://www.medicinesforchildren.org.uk/side-effects-childrens-medicines

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

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.

salmeterol should not be taken with some medicines that you get on prescription. It is important to tell your doctor and pharmacist about any other medicines your child is taking before starting salmeterol.

  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

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

Do not reduce the dose of inhaled steroid without talking to your doctor first, as your child may become very ill.

  • It is important that your child continues to have their inhaled steroids as usual while they are taking salmeterol.
  • 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.
  • 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 medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Where should I 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 salmeterol and about other medicines used to treat asthma.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Asthma UK

0300 222 5800

www.asthma.org.uk/

Copyright disclaimer

Version [2]. © NPPG, RCPCH and WellChild, all rights reserved. Review by November 2018.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.