Fluticasone inhaler (Flixotide): preventer for asthma and COPD explained

Fluticasone is a type of steroid, also called a corticosteroid, and is not the same as an anabolic steroid. The NHS says it works by reducing swelling (inflammation) of the airways in the lungs to make breathing easier, and stops symptoms such as wheezing and coughing developing. It is used for asthma and chronic obstructive pulmonary disease (COPD).

It comes as an inhaler, available as an Evohaler or an Accuhaler, which the NHS says is usually brown, orange or beige and is called a preventer because it helps to prevent symptoms. For severe asthma or COPD a nebuliser may be used, with fluticasone liquid in individual doses called nebules. Some inhalers combine fluticasone with other medicines that help breathing, with brand names including Flutiform, Relvar, Seretide and Trelegy.

Fluticasone also comes as a skin cream for eczema and as a nasal spray or drops for hay fever, allergic rhinitis and nasal polyps, but this page focuses on the inhaler.

Similar preventer inhalers contain other steroids such as beclometasone, budesonide and mometasone. The NHS stresses that inhalers can look very different and some are for adults only, so use only your own inhaler.

The NHS says the usual dose for the inhaler is 1 or 2 puffs twice a day, but inhalers come in different strengths and your doctor, asthma nurse or respiratory nurse will tell you which is right, and you may be told to take more than 2 puffs at a time depending on how severe your breathing is. The usual nebuliser dose is 0.5 mg to 2 mg twice a day. You will be prescribed the lowest dose that controls your symptoms, which may go up or down.

It is important to use the inhaler properly so the right amount gets into your lungs. Read the leaflet for instructions on how to use and clean your inhaler. The NHS says to remove the mouthpiece cover completely before use, check the mouthpiece is clean, shake the inhaler 4 or 5 times to remove loose objects and replace the cover straight away afterwards, because of a risk of choking.

A spacer can make it easier to get the medicine into your lungs and can reduce side effects in the mouth and throat; it is particularly useful for young children. Ask your doctor, nurse or pharmacist to show you. Asthma + Lung UK has short videos showing inhaler techniques.

You will usually use fluticasone for a long time. Keep using it even if you feel better. If you forget a dose, use it as soon as you remember unless it is nearly time for the next one, and do not take two doses to make up. If you agreed a personal action plan with your doctor or nurse, follow it.

Most adults and children aged 4 years and over can use fluticasone inhalers. Most adults can use it in a nebuliser, and children under 18 can use a nebuliser only with advice from a specialist doctor, because they need to be monitored. Tell your doctor if you have had an allergic reaction to fluticasone, 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, or have had tuberculosis.

Fluticasone does not affect contraception, you can drink alcohol, and for most people it will not affect driving or cycling. You do not need to stop it before surgery, because your breathing could worsen; tell the person treating you that you take it, as you may need extra steroids for a while.

The NHS asks you to try not to smoke, because smoking irritates the lungs and fluticasone works better if you do not smoke. Lifestyle steps that help include regular exercise, healthy eating and the annual flu and pneumococcal vaccinations.

With inhaled fluticasone very little medicine gets into the rest of the body, so side effects are unlikely. The most common, affecting more than 1 in 100 people, are oral thrush and a dry or sore throat or hoarse voice. The NHS suggests rinsing your mouth with water or brushing your teeth after each use, and using a spacer. A pharmacist can recommend treatment for thrush and check your technique.

Serious side effects are unusual, and more likely with a high dose for a long time. Speak to a doctor if you get a puffy, rounded face and weight gain in the upper back or belly, which can be a sign of Cushing’s syndrome. Call a doctor or 111 for a high temperature, chills, a very sore throat, a change in mucus colour, pain on peeing or a wound that will not heal, which can be signs of infection; for a very upset stomach, vomiting, severe dizziness, muscle weakness, tiredness, mood changes or weight loss, which can be signs of adrenal gland problems; or for blurred vision or other changes in eyesight, which can be signs of glaucoma, fluid in the eye or cataract.

In children and teenagers, high doses for a long time can slow normal growth, so height and weight are monitored. The NHS says this does not seem to have much effect on adult height.

Adults on high doses by inhaler or nebuliser have an increased risk of adrenal gland problems or weak bones over time, so they are monitored and may be given medicines to strengthen bones; calcium-rich foods and regular exercise can help.

A serious allergic reaction is rare but is a 999 emergency. It is different from an asthma attack: if you or your child have wheezing or chest tightness, use your reliever as advised and call 999 or go to A&E if it does not improve.

The NHS explains that steroid medicines can mean the adrenal glands do not make enough of hormones such as cortisol. This adrenal insufficiency is more likely with high doses for a long time, especially tablets and injections, or if you regularly use several kinds of steroids together, such as a steroid nasal spray and an inhaler.

Your doctor or pharmacist assesses your risk and may recommend a red steroid emergency card, which you show to a doctor or dentist if you need treatment or surgery so they can give extra steroids if needed. If you take a high dose you will also be given a blue steroid treatment card with details of your doctor, dose and how long treatment will last.

The NHS says the Addison’s Disease Self-Help Group has more information about the NHS steroid emergency card.

Inhalers for asthma and COPD are prescribed on the NHS through GPs and respiratory clinics. Asthma reviews with an asthma nurse should include technique checks and a personal action plan. Private respiratory physicians prescribe the same medicines. Whichever route, ask for your technique to be checked at least yearly.