The more frequent use of short-acting bronchodilators to relieve symptoms indicates a worsening of control over the disease, and in such situations the patient should consult a doctor.
The sudden and increasing deterioration in the control of bronchial asthma poses a potential threat to life, and in such situations, the patient should also consult a doctor.The doctor should consider the possibility of a higher dose of GCS. If the dose of Salmecort used does not provide adequate control over the disease, the patient should also consult a doctor.
Patients with asthma can not dramatically reduce the treatment with Salmecort because of the danger of aggravation, the dose of the drug should be reduced gradually under the supervision of a doctor. In patients with COPD, the withdrawal of the drug may be accompanied by symptoms of decompensation and requires the supervision of a physician.
In patients with COPD receiving Salmecort, an increase in the incidence of pneumonia is possible (see section "Side effect"). Doctors should be aware of the possibility of developing pneumonia in patients with COPD, as the clinical picture of exacerbation of COPD and pneumonia is often similar.
Any inhaled GCS can cause systemic reactions, especially with prolonged use in high doses; but the likelihood of such symptoms is much lower than when treated with oral GCS (see the section "Overdose"). Possible systemic reactions include Cushing's syndrome, cushingoid features, suppression of adrenal function, growth retardation in children and adolescents, reduction of bone mineral density, cataract and glaucoma.
Therefore, in the treatment of asthma, it is important to reduce the dose to the lowest dose, which provides effective control over the disease.
In emergency and planned situations that can cause stress, it is always necessary to remember the possibility of suppressing the function of the adrenal gland and be ready for use by the GCS (see section "Overdose").
When carrying out resuscitation measures or surgical interventions, it is required to determine the degree of adrenal insufficiency. It is recommended to regularly measure the growth of children who receive prolonged therapy with inhaled glucocorticosteroids.
Because of the possibility of adrenal suppression, patients transferred from oral corticosteroids to inhalation of fluticasone propionate therapy should be treated with extreme caution and regular monitoring of their function of the adrenal cortex. When transferring patients from taking systemic GCS to inhalation therapy, allergic reactions (for example, allergic rhinitis, eczema), which were suppressed by systemic GCS, may appear. In such situations it is recommended to carry out symptomatic treatment with antihistamines and / or topical preparations, including SCS for topical application.
After initiation of treatment with inhaled fluticasone propionate, systemic GCS should be discontinued gradually, and such patients should carry a special patient card containing an indication of the possible need for additional administration of SCS in stressful situations.
In patients with exacerbation of bronchial asthma, hypoxia, it is necessary to monitor the concentration of potassium K + ions in the plasma.
There are very rare reports of an increase in blood glucose levels, and this should be borne in mind when appointing a combination of salmeterol with fluticasone propionate in patients with diabetes mellitus (see section "Side effect").
Because of the potential for systemic effects of GCS, including Cushing's syndrome and suppression of adrenal function, fluticasone propionate and ritonavir should be avoided, unless the potential benefit to the patient exceeds the risk associated with systemic SCS effects (see "Interaction with other medicinal products ").
When taking salmeterol, the risk of serious unwanted reactions from the respiratory system or death in patients of African-American origin is presumably higher,than in other patients. The importance of pharmacogenetic factors or other causes is unknown. The effect of concomitant use of inhaled glucocorticosteroids on the risk of lethal outcomes in patients with asthma has not been studied.
Like other inhaled drugs, Salmecort can cause a paradoxical bronchospasm, manifested by the increase in dyspnea immediately after use. In this case, rapid and short-acting inhalation bronchodilator should be immediately applied, Salmecort should be canceled and, if necessary, alternative therapy should be started (see "Side effect" section).
There may be adverse reactions associated with the pharmacological action of beta2-antagonists, such as tremor, subjective palpitation and headache. However, these reactions are of a short-term nature, and their severity decreases with regular therapy (see section "Side effect").