Foster

Foster is a combination inhaler that contains two active ingredients: the inhaled corticosteroid beclometasone and the long-acting bronchodilator formoterol. It is used to treat asthma and COPD.

The special formulation (extrafine particles) allows good distribution even in the small airways. Foster 100/6 µg can be used both as regular maintenance therapy and as an as-needed medication (MART concept).

The inhaler is available as a metered-dose inhaler and as a dry powder inhaler (Foster Nexthaler).

Foster combines two mechanisms of action:

Beclometasone (corticosteroid):

• Reduces inflammation in the airways
• Decreases swelling and mucus production
• Reduces the hyperresponsiveness of the bronchi
• Long-term effect – protects against asthma attacks

Formoterol (LABA – long-acting beta-2 agonist):

• Widens the bronchi
• Works within minutes
• Duration of action: 12 hours
• Can also be used as a reliever when needed

Synergistic effect: The combination is more effective than the individual active ingredients. Corticosteroids increase the number of beta-2 receptors, and beta-2 agonists enhance the anti-inflammatory effect of corticosteroids.

Foster is suitable for:

• Adults with moderate to severe asthma
• When an inhaled corticosteroid alone is not sufficient
• As MART therapy (Maintenance And Reliever Therapy; 100/6 µg formulation only)
• COPD (100/6 µg formulation)

Not suitable:

• As the sole acute initial treatment of asthma attacks
• For children under 18 years of age (depending on the formulation)
• In mild asthma that occurs only occasionally

MART concept: Foster 100/6 µg can be used both as daily maintenance therapy (2 times daily) and additionally as needed.

Foster metered-dose inhaler:

• 100/6 µg (beclometasone/formoterol) per puff
• 200/6 µg (beclometasone/formoterol) per puff

Foster Nexthaler (powder):

• 100/6 µg per single dose
• 200/6 µg per single dose

Recommended dosage for asthma:

• 1-2 puffs 2 times daily (maintenance therapy)
• With MART (100/6 µg strength only): 1 puff 2 times daily + additionally as needed (max. 8 puffs/day)

For COPD:

• 2 puffs 2 times daily (100/6 µg strength only)

Metered-dose inhaler: 1. Remove the protective cap and check that the mouthpiece is clean 2. Breathe out deeply 3. Close your lips firmly around the mouthpiece 4. Breathe in slowly and deeply while releasing a puff 5. Hold your breath for approx. 10 seconds 6. Breathe out slowly 7. Rinse your mouth after inhalation (to prevent fungal infection)

Nexthaler (dry powder inhaler): 1. Open the protective cap 2. Breathe out deeply (not into the inhaler!) 3. Close your lips around the mouthpiece 4. Breathe in quickly and deeply 5. Hold your breath 6. Close the mouthpiece 7. Rinse your mouth

Important:

• Use regularly, even if you have no symptoms
• After inhalation, rinse your mouth with water and spit it out
• Do not change the dose on your own

Foster must not be used in cases of:

• Hypersensitivity to beclometasone, formoterol or the excipients

Caution in cases of:

• Active or quiescent pulmonary tuberculosis
• Fungal, viral or bacterial infections of the airways
• Severe cardiovascular diseases
• QT prolongation
• Diabetes mellitus
• Hyperthyroidism
• Pheochromocytoma
• Hypokalemia

Pregnancy: Only if clearly indicated. In asthma, controlling the disease is more important than theoretical risks.

Breastfeeding: Use is possible after weighing the benefits and risks.

Common (1-10%):

• Oral thrush (fungal infection in the mouth) – preventable by rinsing your mouth
• Hoarseness
• Headache
• Tremor
• Palpitations

Uncommon (0.1-1%):

• Cough after inhalation
• Dry mouth
• Muscle cramps
• Restlessness, nervousness

Rare:

• Systemic corticosteroid effects (with high doses, long-term use)
• Paradoxical bronchospasm
• Hypokalemia
• Hyperglycemia

Preventing oral thrush: After each inhalation, rinse your mouth thoroughly with water and spit the water out.

Interactions with:

• Beta blockers – may weaken the effect of formoterol
• QT-prolonging medicines – risk of heart rhythm disorders
• Potassium-lowering medicines (diuretics, corticosteroids) – risk of hypokalemia
• CYP3A4 inhibitors (ritonavir, ketoconazole) – increased corticosteroid levels

Combination not recommended:

• Other long-acting beta-2 agonists (duplication)
• Non-selective beta blockers in asthma