Salmeterol

What is salmeterol?

Salmeterol is used to improve breathing problems caused by asthma and COPD and to prevent them from recurring. It eases symptoms such as wheezing, coughing and shortness of breath. Salmeterol works by opening air passages in your lungs to make breathing easier.

• Salmeterol must be used every day. It is a long-acting bronchodilator, which means that it works throughout the day. It reduces your symptoms over the long term. 
• For asthma, salmeterol should be used together with other medicines called corticosteroids ,or preventers such as beclomethasone, budesonide or fluticasone. 

In New Zealand, salmeterol is available in different brands and inhaler devices – metered dose inhaler (MDI or puffer)or accuhaler (a dry powder inhaler).

Using an inhaler device enables the medicine to go straight into your airways when you breathe in. This means that your airways and lungs are treated, but very little of the medicine gets into the rest of your body.

Both the MDI and accuhaler are effective. The choice of device is a personal preference. Read more about the different inhaler devices and how to decide on the right inhaler for you.

Dose

• The dose of salmeterol will be different for different people depending on the severity of your symptoms and the strength of your inhaler or accuhaler.
• The usual dose of salmeterol is 1 or 2 inhalations twice a day.
• Always use your salmeterol exactly as your doctor has told you.
• The pharmacy label on your medicine will tell you how much to use, how often to use it and any special instructions.

Tips

• Keep using your inhaler every day. Don't stop using it, even if you feel better.
• Because asthma and COPD are long-term conditions, prevention with salmeterol is ongoing. You need to use it every day for months or years.
• Try to use your inhaler at the same time each day, to help you to remember to use it regularly.
• If you miss a dose, you can take it as soon as you remember. But if it is nearly time for your next dose, just take your next dose at the right time.

How to use your MDI (puffer)

To get the most benefit, it's important to use the correct technique. Ask your doctor, pharmacist or nurse to explain how to use your inhaler. Even if you have been shown before, if you still have any questions, ask them to show you again how to use your inhaler. Here is some guidance.

How to use your MDI (puffer)
	Take off the cap and hold the inhaler upright.
	Shake the inhaler to mix the medicine.
	Sit upright, tilt your head back slightly (as if you are sniffing) and breathe out gently.
	Hold the device upright, insert the inhaler into your mouth, ensuring that your lips firmly seal the mouthpiece. At the beginning of a slow, deep breath, breathe in through the mouthpiece at the same time as you press the inhaler to release 1 dose or ‘puff’.
	Breathe in fully, remove the inhaler from your mouth and hold your breath for 10 seconds or as long as is comfortable. Breathe out gently through your nose.

Learn more about metered dose inhalers.

Using a spacer with your MDI

A spacer is an attachment to use with your MDI. Using a spacer with your MDI makes it easier to use the inhaler. It helps to get the medicine into your lungs, where it’s needed (with less medicine ending up in your mouth and throat). Spacers improve how well your medicine works. Read more about spacers.

How to use your accuhaler

To get the most benefit, it's important to use the correct technique. Ask your doctor, pharmacist or nurse to explain how to use your accuhaler. Here is some guidance:

Source: NHS, UK, 2016

Using your accuhaler

• Open: Hold the accuhaler in one hand, and with the thumb of your other hand push the thumb grip away from you until you hear a click. This reveals the mouthpiece.
• Load the dose: Hold the inhaler in a horizontal position. Slide the lever away from you until you hear a click.
• Breathe out: Breathe out, away from the accuhaler. Do not blow directly into your device.
• Inhale your dose: Place the mouthpiece in your mouth and form a seal with your lips. Breathe in deeply and forcefully through your mouth. Remove the accuhaler and hold your breath for up to 10 seconds. If you need another dose, wait for 30 seconds and then repeat the process.
• Close: Close the inhaler by sliding the thumb grip towards you.

Cleaning and storing your accuhaler: Wipe the mouthpiece with a clean dry tissue. Don't wash the mouthpiece or let it get wet when cleaning. Close the device when not in use. 

When to start a new accuhaler: There is a window on the side of the accuhaler called a dose counter. When it turns red, it's time to get a new accuhaler.

Precautions before using salmeterol

• Do you have heart disease?
• Do you have an overactive thyroid (hyperthyroid)?
• Do you have high blood pressure (hypertension)?
• Do you have diabetes?
• Do you have lactose intolerance?
• Are you pregnant or breastfeeding?
• Do you have an irregular heartbeat or rhythm, including a very fast pulse?
• Do you play competitive or professional sport?

If so, it’s important that you tell your doctor or pharmacist before you start using salmeterol. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What are the side effects of salmeterol?

Like all medicines, salmeterol can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Learn more

Serevent accuhaler Medsafe Consumer Information, NZ
Serevent inhaler Medsafe Consumer Information, NZ
Salmeterol NZ Formulary Patient Information

References

1. Salmeterol NZ Formulary

Useful resources for healthcare professionals

Serevent accuhaler Medsafe, NZ
Serevent inhaler Medsafe, NZ
The optimal management of patients with COPD – part 1 – the diagnosis February 2015
The optimal management of patients with COPD – Part 2 – stepwise escalation of treatment BPAC, NZ, 2015