ICS + LABA combination inhaler Pregnancy: There are no relevant clinical data on the use of Fostair in pregnant women; animal studies of the beclometasone dipropionate and formoterol combination showed evidence of reproductive toxicity after high systemic exposure. Fostair should only be used during pregnancy if the expected benefits outweigh the potential risks. Because of the tocolytic actions of beta2-sympathomimetics, particular care should be exercised in the run up to delivery — formoterol is not recommended during pregnancy and particularly at the end of pregnancy or during labour unless there is no other (safer) established alternative. Breast-feeding: no relevant clinical human data; it is reasonable to assume beclometasone dipropionate is secreted in milk like other corticosteroids and formoterol has been detected in the milk of lactating animals — administration to breast-feeding women should only be considered if the expected benefits outweigh the potential risks. Fertility: no human data; in rats, high doses of beclometasone dipropionate in the combination were associated with reduced female fertility and embryotoxicity.

Beclometasone with formoterol

Brand names: Fostair

Used in: Asthma

This is a combination inhaler of the inhaled corticosteroid beclometasone with the long-acting beta-2 agonist formoterol, used for maintenance treatment of asthma and COPD and, in some products, as combined maintenance and reliever therapy in asthma.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Two inhalations twice daily (adults 18 years and above) — source product delivers beclometasone dipropionate 200 micrograms / formoterol fumarate 6 micrograms per actuation

Route: Inhalation (pressurised metered dose inhaler; an AeroChamber Plus spacer may be used by patients who find it difficult to synchronise actuation with inspiration) — source product: Fostair 200/6 micrograms per actuation pressurised inhalation solution — source product: Fostair 200/6 micrograms per actuation pressurised inhalation solution (WITH dose counter)

Frequency: Twice daily

Max: The maximum daily dose is 4 inhalations

Source: UK SPC (eMC) §4.2 for Fostair 200/6 micrograms per actuation pressurised inhalation solution (https://www.medicines.org.uk/emc/product/5076/smpc). Verbatim: 'Dose recommendations for adults 18 years and above: Two inhalations twice daily. The maximum daily dose is 4 inhalations.' STRENGTH-SPECIFIC: 'Fostair 200/6 should be used as maintenance therapy only. A lower strength (Fostair 100/6) is available for maintenance and reliever therapy' — this draft therefore covers the MAINTENANCE-ONLY 200/6 strength; the maintenance-and-reliever (MART) regimen belongs to the 100/6 strength and is not stated in this label. Patients should be advised to have their separate short-acting bronchodilator available for rescue use at all times. Fostair is NOT intended for the initial management of asthma. EXTRAFINE PARTICLE SIZE: 100 micrograms of beclometasone dipropionate extrafine in Fostair are equivalent to 250 micrograms of beclometasone dipropionate in a non-extrafine formulation, so the total daily dose of beclometasone dipropionate given as Fostair should be lower than with a non-extrafine formulation — take this into account when transferring a patient. STEP-DOWN: Fostair 200/6 should not be used for step-down treatment; the lower strength (Fostair 100/6) is available for step-down. Titrate to the lowest dose at which effective control of symptoms is maintained; patients should take Fostair every day even when asymptomatic and treatment should not be stopped abruptly. ELDERLY: there is no need to adjust the dose. PAEDIATRIC: 'Fostair 200/6 should not be used in children and adolescents less than 18 years' — no paediatric dose is stated, so paedDose is null; verify any under-18 use against a children's formulary. ADMINISTRATION: prime with one actuation into the air before first use or if unused for 14 days or more; hold the inhaler vertically; wait about half a minute between puffs; rinse the mouth or gargle with water, or brush the teeth, after inhaling.

Dose adjustments

Renal

There are no data available for use of Fostair in patients with hepatic or renal impairment

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients listed in section 6.1

Side effects

Common: pharyngitis, oral candidiasis and dysphonia (rinse the mouth or gargle after inhaling); common: headache
Uncommon: tremor, dizziness, restlessness; uncommon: cough, productive cough, throat irritation, pharyngeal erythema, asthmatic crisis; rare: paradoxical bronchospasm
Uncommon: palpitations, ECG QTc interval prolongation, ECG change, tachycardia, tachyarrhythmia, atrial fibrillation; rare: ventricular extrasystoles, angina pectoris
Uncommon: hypokalaemia and hyperglycaemia; uncommon: muscle spasms and myalgia; uncommon: granulocytopenia; very rare: thrombocytopenia
Very rare: adrenal suppression, glaucoma, cataract, growth retardation in children and adolescents; uncommon: pruritus, rash, hyperhidrosis, urticaria (rare angioedema); very rare hypersensitivity reactions including erythema and lip, face, eye and pharyngeal oedema

Interactions

§4.4: hypokalaemia may be potentiated by concomitant treatment with other drugs which can induce hypokalaemia, such as xanthine derivatives, steroids and diuretics (see section 4.5) — monitoring serum potassium is recommended in unstable asthma when a number of rescue bronchodilators may be used
§4.4: if anaesthesia with halogenated anaesthetics is planned, ensure Fostair is not administered for at least 12 hours before the start of anaesthesia because of the risk of cardiac arrhythmias
§4.4: caution with medicinal products known or suspected to prolong the QTc interval (QTc > 0.44 seconds), either congenital or drug induced — formoterol itself may induce QTc prolongation
Note: §4.5 itself was not retrieved (the §4.4 text was truncated at the source-fetch limit); verify against the complete SPC

Clinical monograph

How it works

Beclometasone suppresses airway inflammation via glucocorticoid receptors while formoterol provides rapid-onset, long-acting bronchodilation through beta-2 adrenoceptor stimulation.

Prescribing in practice

Most important: in asthma a long-acting beta-2 agonist must always be combined with an inhaled corticosteroid, so this fixed inhaler should replace, not supplement, any separate LABA and steroid adherence is essential.
Where licensed for maintenance-and-reliever therapy, ensure the patient understands the single-inhaler regimen and does not also use a separate LABA reliever.
Prescribe by brand and device, as extra-fine formulations are not dose-equivalent to other combinations.

Monitoring

Monitor asthma or COPD control, inhaler technique, oral candidiasis, and growth in children on long-term inhaled corticosteroid.

Counselling the patient

Rinse the mouth after dosing to lower the risk of oral thrush.
Follow the prescribed regimen exactly, particularly if this inhaler is also your reliever.

Evidence & guidelines

ICS/LABA combinations are established maintenance therapy in NICE, GINA and GOLD guidance, including MART regimens in asthma.

Reference: NICE NG80; BTS/SIGN; GINA; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Budesonide with formoterol · ICS + LABA combination inhaler

Pathways