Salmeterol

Why salmeterol runs on a clock

If your chest tightens during the night, the medicine doing the quiet work is often a long-acting bronchodilator. Salmeterol opens the airways and keeps them that way for roughly half a day. It is used in asthma and in COPD — the long-term lung conditions that take in chronic bronchitis and emphysema — and to prevent the breathlessness some people get with exercise. As a preventer it works on a schedule and is no help once an attack is under way. The four products below sit in the shop's asthma and respiratory care section.

How it holds the airways open

Salmeterol is a beta-2 agonist. It settles onto beta-2 receptors on the muscle in the airway walls and holds that muscle relaxed, so breathing takes less effort. Half a day of cover from one dose is why the routine is a dose in the morning and another in the evening, roughly twelve hours apart, rather than something reached for when symptoms appear. In asthma it is never used alone: it goes with an inhaled corticosteroid, which calms the inflammation underneath the narrowing. Every product here is that pair in one device.

Taking a salmeterol inhaler

Advair Diskus is a powder inhaler, Seroflo is an aerosol that sprays a measured puff, and Advair Rotahaler uses capsules loaded into a small device. Whichever you pick, the pattern is two doses a day, morning and evening, whether your chest feels tight or not. For breathlessness that exercise brings on, inhale at least 30 minutes before the activity and keep 12 hours from your last dose; if you already dose twice daily, you are covered and add nothing. Rinse your mouth with water and spit after each dose to prevent thrush (a yeast infection with white patches or soreness), and shield the device from damp and heat.

Side effects, common and urgent

Headache, tremor, a sore or hoarse throat, cough and a faster pulse are what people report most, and thrush is likelier because a steroid shares the inhaler. Some effects cannot wait: wheezing that worsens straight after a dose, a pounding heartbeat with chest pain, or an allergic reaction (a spreading rash, swollen lips, tongue or throat, sudden trouble breathing) all need emergency care. In asthma, salmeterol alone raises the risk of an attack severe enough for hospital, so it is always taken with a steroid and kept to the shortest time needed.

The salmeterol products

All four pair salmeterol with fluticasone. Advair Diskus is a dry-powder inhaler in three strengths: 100/50mcg, 250/50mcg and 500/50mcg. Fluticasone + Salmeterol is the same pair under a plain name, in 250/50mcg and 500/50mcg. Seroflo Inhaler is an aerosol, and its strengths read the other way round: 25/125mcg and 25/250mcg mean 25mcg of salmeterol with 125mcg or 250mcg of fluticasone. Advair Rotahaler is a set of capsules that go into a Rotahaler device.