Generic Name

Qvar Redihaler

Mechanism

• Glucocorticoid receptor binding: Fluticasone propionate gains intracellular access, binds to cytosolic glucocorticoid receptors, complexes, and translocates to the nucleus.
• Transcriptional regulation: The complex recruits co‑activators or recruits co‑repressors, leading to:
• ↓ synthesis of pro‑inflammatory cytokines (IL‑5, IL‑13, TNF‑α)
• ↓ recruitment of eosinophils and neutrophils
• ↑ anti‑inflammatory proteins (lipocortin‑1).
• Reduced airway hyper‑responsiveness: Decreases airway smooth‑muscle hypertrophy and submucosal edema.
• Local airway immunosuppression: Limits episodic bronchoconstriction and inflammation.

Pharmacokinetics

Indications

• Persistent asthma (mild‑moderate to severe) requiring daily controller therapy.
• Used as monotherapy for stable asthma or as add‑on to short‑acting β₂‑agonists (SABA).
• Can be tapered when remission is achieved and symptoms are controlled.

Contraindications

• Contraindications
• Hypersensitivity to fluticasone propionate, propionate esters, or any component.
• Active systemic fungal infections (e.g., candidiasis) that may worsen.
• Warnings
• Growth suppression in children; monitor annually.
• Adrenal suppression with high cumulative doses or concurrent systemic steroids.
• Local candidiasis—use oral rinse after each use.
• Exacerbation of pneumonia in immunocompromised patients.
• Precautions
• Use with caution in patients on potent CYP3A4 inhibitors or inducers.
• Avoid in patients with a history of thymic malignancies or interstitial lung disease.

Dosing

*Administration notes:*
• Hold inhalation for 10 s after exhaling; breathe in slowly and deeply.
• Use a spacer or valved holding chamber if coordination is difficult.
• Rinse mouth post‑dose to reduce fungal risk.

Adverse Effects

Serious events are rare when used at recommended doses; monitor especially in pediatrics and if high cumulative exposure.

Monitoring

• Pulmonary function (FEV₁, peak expiratory flow) → baseline and every 3–6 months.
• Growth velocity in children → annually.
• Signs of systemic absorption: blood pressure, serum cortisol (if clinically indicated).
• Oral candidiasis: Inspect oral cavity at each visit.
• Adherence & technique: Review inhaler technique at each encounter.

Clinical Pearls

• Pre‑dose rinse: Rinsing the mouth or gargling with salt water after each puff dramatically reduces oral candidiasis—especially in school‑going kids.
• Spacer synergy: A valved holding chamber improves deposition in the lower airways and reduces oral deposition.
• Dose escalation in adolescence: Start at 50 µg BID; if symptoms persist, add a second puff only after failure of bronchodilators and rescue therapy for at least 1 month.
• Avoid abrupt withdrawal: Taper slowly when discontinuing after long‑term use to prevent adrenal crisis.
• Use as a proof‑of‑concept: For patients who cannot tolerate alternate inhaled steroids, Qvar Redihaler can serve as a high‑potency, low‑dose alternative—mono‑therapy up to 200 µg/day.
• Drug–drug interactions: Screen for potent CYP3A4 inhibitors (ketoconazole, ritonavir). If concomitant therapy is mandatory, consider reducing Qvar dose or switching to another controller.

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• Key take‑away: *Qvar Redihaler* delivers an effective, low‑systemic‑dose corticosteroid for stable asthma, but requires diligent inhaler technique, routine monitoring of growth (in children) and careful attention to potential local fungal infections.