Dosage of Salmeterol Fluticasone MDI in the Elderly

Dosing Guidelines for Salmeterol/Fluticasone

The American College of Allergy, Asthma, and Immunology recommends that the dose of salmeterol/fluticasone MDI for elderly patients is the same as for other adults, typically 2 inhalations twice daily, with the specific strength depending on asthma severity or level of control 1, 2
The standard adult dose of salmeterol is 50 mcg every 12 hours, as recommended by the American College of Allergy, Asthma, and Immunology 1
For fluticasone component, dosing ranges from low to high based on asthma severity, with low dose: 88-264 mcg/day, medium dose: >264-440 mcg/day, and high dose: >440 mcg/day, as recommended by the American College of Allergy, Asthma, and Immunology 3

No specific dose adjustment is required based on age alone, according to the American College of Allergy, Asthma, and Immunology 1, 2, 3
Elderly patients may be more susceptible to side effects such as tremor from salmeterol and systemic effects of fluticasone, as reported in Thorax 4
Caution is advised in elderly patients with ischemic heart disease, as beta agonists may require ECG monitoring with the first dose, as reported in Thorax 4

Fluticasone/salmeterol MDI is available in different strengths, including 44/21 mcg per puff, 110/21 mcg per puff, and 220/21 mcg per puff, as recommended by the American College of Allergy, Asthma, and Immunology 3

Exhale fully before placing the mouthpiece between lips, inhale deeply and slowly while pressing down on the canister, and hold breath for 10 seconds if possible, as reported in Thorax 4
Using a spacer device can increase medication delivery, especially important for elderly patients who may have coordination difficulties, as reported in BMJ 5, 6

Salmeterol may cause tachycardia, skeletal muscle tremor, and hypokalemia, as reported in the Journal of Allergy and Clinical Immunology 1

Assess cognitive function and physical ability to use the MDI properly; consider alternative delivery devices if coordination is poor, as reported in Thorax 4
Elderly patients with comorbidities such as cardiovascular disease require closer monitoring, as reported in Thorax 4

Failing to assess proper inhaler technique, which is especially important in elderly patients who may have coordination difficulties, as reported in Thorax and BMJ 4, 5
Not using a spacer device when appropriate, which can improve drug delivery and reduce local side effects, as reported in BMJ 5
Not monitoring for potential drug interactions with other medications commonly used by elderly patients, as reported in a medical journal 7