Fostair inhaler - common questions and answers
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FOSTAIR inhaler – TOP questions & ANSWERS

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Fostair inhaler is a popular combination inhaler used in the management of asthma and COPD. In asthma, Fostair is usually recommended when a condition is not well controlled with the use of inhaled steroid and short-acting beta2-agonist (like Ventolin) or condition is controlled with two separate inhalers (corticosteroid and long-acting beta2-agonists). Patients with severe COPD are usually prescribed Fostair. In this case, Fostair is used to help manage COPD symptoms. 

1. What are the main active ingredients in Fostair?

Fostair has two active ingredients:

  • Beclomethasonesteroid component of the inhaler. Inhaled corticosteroids are used in asthma as they produce an anti-inflammatory effect.
  • Formoterol, which belongs to a group of drugs called long-acting beta2-agonist (LABA). Formoterol opens-up the airways, improving breathing.

 2. What is a combination inhaler?

As we already learned from the above combination inhaler in asthma contains two ingredients, one of which is inhaled corticosteroid and the other LABA. LABA (formoterol) should not be used on its own. The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that LABA should always be taken with inhaled corticosteroids. Some evidence exist which indicates that use of LABA on its own may cause worsening of asthma in some cases, severe worsening (NICE, 2015).

3. In what strength does Fostair come in?

Fostair comes in two different strengths:

  • Fostair 100/6: 100 micrograms of beclometasone dipropionate and 6 micrograms of formoterol fumarate dihydrate
  • Fostair 200/6: 200 micrograms of beclometasone dipropionate and 6 micrograms of formoterol fumarate dihydrate

4. What type of inhaler is Fostair?

Fostair inhaler is classified as pressure metered-dose inhaler (pMDI). pMDI inhalers are composed of an aluminium canister with a propellant (spray) and an active drug inside, metering valve, and actuator. 

5. Is Fostair a pink inhaler?

As we learned, Fostair inhaler comes in two different strengths. Lower strength inhaler (most commonly prescribed) has a pink body and dark-pink mouthpiece cover, whereas a higher-strength Fostair has a pink body with green mouthpiece cover.

Fostair pink inhaler vs Fostair green inhaler
Fostair pink inhaler (100/6) and Fostair green inhaler (200/6)

6.What are the side effects of Fostair inhaler?

The most common side effects associated with Fostair use include:

  • Oral thrush: like with other steroid inhalers, it is recommended to rinse the mouth to reduce the likelihood of oral thrush infection.
  • Headache
  • Dysphonia (voice hoarseness)

For less common side effects, please refer to product information leaflet.

7. How often is Fostair used?

When used in treatment in the maintenance of asthma, Fostair is used twice a day. A GP may recommend using Fostair as a reliever (see next paragraph). Follow directions of your GP on the use of the inhaler.

8. Can you use Fostair as a ‘reliever’?

Initial license for Fostair included only maintenance therapy in adults over 18 years of age. In 2012 licensed was updated and since then Fostair can also be used as a reliever, taken accordingly to asthma symptoms.

It was established that that use of Fostair as a reliever and in the maintenance therapy in patients with uncontrolled asthma notably increased time to severe exacerbation by 75 days. In this study treatment with Fostair (reliever & maintenance) was compared to treatment with Fostair (maintenance) and salbutamol inhaler as a reliever (NICE, 2013.

9. How to use Fostair inhaler?

Patients should prime the inhaler before the first use or if inhaler was not used for 14 days or longer. The inhaler is primed by releasing a puff into the air.

Fostair is classified as a pressure metered-dose inhaler (pMDI). Video below illustrates how pMDIs should be used.

10. Is Foster a ‘stronger’ inhaler?

Asthma is a condition, which is managed in a step-up manner. Patients start therapy with a short-acting reliever (e.g. Salbutamol) and move into a combination therapy with an inhaled corticosteroid and a reliever (two separate inhalers).

Long-acting betas2-agonists are recommended at step 3 of asthma management. Fostair is not usually recommended as the first-line inhaler in the management of asthma. This is because Fostair is more potent, ‘stronger’, than some other corticosteroid inhalers. Improved potency comes from properties of beclomethasone dipropionate, which comes in the form of extra fine particles, allowing more efficient delivery of the drug into the lungs.

As an example, 100 micrograms of beclomethasone dipropionate extra fine particles found in Fostair are equivalent to 250 micrograms of beclometasone dipropionate found in a non-extra fine formulation like Clenil Modulite 250micrograms inhaler.

11. Do I need a spacer with Fostair?

Spaces are devices which reduce the need for coordination when a pressure meter dose inhaler is used. A spacer is attached at the end of inhaler’s mouthpiece. Spacers reduce the speed of particles which exist the inhaler into a long plastic tube.

The main advantages of spacers are improved delivery of inhaled medication into the lungs and reduced risk of getting an oral thrush, which is a common side effect of combination inhalers. It is not necessary to use a spacer with Fostair inhaler; however, spacers improve drug delivery in patients with poor coordination. A spacer may offer drug delivery benefits in a wider patient group. Examples of popular spacers compatible with Fostair:

  • Aerochamber Plus®
  • Able Spacer®
  • Space Chamber Plus

When needed, spacers are usually prescribed by a doctor; however, spacers can be purchased without a prescription from a pharmacy or online.

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AeroChamber Plus spacer for Fostair inhaler
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  • Improves the delivery of Metered Dose Inhalers used with AeroChamber due to medication not adhering to chamber walls
  • Built-in, one-way valve opens easily and prevents exhalation back into the chamber
  • Fits most commonly prescribed MDIs

12. Can children use Fostair?

Fostair inhaler is licensed for the treatment of asthma or COPD in adults over 18 years of age. Use of Fostair in people aged below 18 years of age would be unlicensed. Doctors can prescribe medicines outside their license; however, licensed drugs are mostly the first choice.

13. Can you get inhaler without a prescription?

No. Fostair is prescription-only medication (POM). POM medicines can only be issued on a prescription written by a qualified prescriber, for example, a doctor or an independent prescriber. A prescription can be written by an NHS doctor or privately. When a private prescription is issued, patients cover the cost of medicine supplied.  

14. Can you buy Fostair inhaler?

It is possible to buy Fostair inhaler online. Several online pharmacies offer a private service, which allows asthmatic patients to purchase Fostair after an online consultation (questionnaire). You may need to consent to allow access to your Summary Care Records (SCR). SCR is an NHS system which provides patient’s information, created from GP medical records, for example, information on patient’ repeated medications. Accessing SCR would allow conformation between information provided during your order and NHS records.

As part of the service a private prescription is issued (usually included in service charge). Although convenient, this option of getting an inhaler is more expensive than getting inhaler on private prescription directly from the pharmacy.

 15. How much does Fostair inhaler cost?

Price for the inhaler applies only to patients who bring a private prescription to a pharmacy, regardless of their age or NHS exemption status. All pharmacies will charge an additional mark-up on top of the trade price, which is usually 10-20%.

Patients who get medicines prescribed after visiting NHS doctor, pay a standard prescription charge or get it for free if they are exempt from paying.

Fostair comes in two different strength. The price for both inhalers is the same (prices taken 11/2020, AHH Pharmaceuticals:    

    • Fostair 100/6. Trade price £29.32 with 20% mark-up £35.18  
    • Fostair 200/6. Trade price £29.32 with 20% mark-up: £35.18

16. Do I need to keep Fostair in the fridge?

Fostair should be kept in the fridge (2-8°C) before dispensing inhaler to the patient.

After use Fostair should be kept in room temperature, below 25°C, for a maximum of 3 months. 

Most pharmacies will store the Fostair in the fridge after the dispensing, which is removed from the fridge when the patient comes to collect their medicine. A date can be written on the side of Fostair’s box, indicating when inhaler was removed from the fridge.   

17. I ran out of Fostair. What can I do?

If surgery is open, contact your GP. GP can end an electronic prescription to any pharmacy in the country. If a patient ran out of their inhaler outside of surgery opening hours, an emergency supply of medication could be requested in the pharmacy. Patients cover the cost of a drug, which is supplied on an emergency basis. 

Alternatively, patients may contact NHS 111 service to get NHS referral to a pharmacy, which can issue an ‘emergency prescription‘. In this case, patients are exempt from paying or pay standard NHS prescription charge. Read more about the emergency supply of medication.

18. Can you recycle Fostair?

GSK (a pharmaceutical company) ran an inhaler recycling scheme until September 2020. Sadly, this service is no longer active. Patients should bring old/unwanted inhaler(s) to the pharmacy for safe disposal. Read more about the disposal of unwanted medicines

19. What are Fostair alternative inhalers?

At the moment Fostair is the only device which is a combination inhaler containing beclometasone dipropionate and formoterol fumarate. Other combination inhalers containing corticosteroid and LABA exist and are commonly prescribed:

  • Seretide inhaler: a combination of fluticasone propionate (corticosteroid) and salmeterol xinafoate (LABA)
  • Sirdupla inhaler: combination inhaler of fluticasone propionate (corticosteroid) and salmeterol xinafoate (LABA)
  • Symbicort Turbuhaler: a combination of budesonide (corticosteroid) and formoterol fumarate dihydrate (LABA)

References:

NICE (2013). Asthma: beclometasone/formoterol (Fostair) for maintenance and reliever treatment. Available at: https://www.nice.org.uk/advice/esnm22/chapter/Key-points-from-the-evidence Accessed on 19/11/2020

NICE (2015). Asthma: medicines safety priorities. Available at: https://www.nice.org.uk/advice/ktt5/chapter/Evidence-context Accessed on 18/11/2020

 

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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