FOSTER 100 micrograms / 6 micrograms / actuation pressurized inhalation solution

2. What you need to know before you start using Foster

Do not use Foster:

• If you are allergic to beclometasone dipropionate or formoterol fumarate dihydrate or if you are allergic to other medicines or inhalers used to treat asthma or to any of the other components of this medicine (listed in section 6: Contents of the pack and other information), ask your doctor for advice.

Warnings and precautions

Consult your doctor, pharmacist, or nurse before using Foster:

• If you have heart problems, such as angina (heart pain, chest pain), a recent heart attack (myocardial infarction), heart failure, narrowing of the arteries surrounding the heart (coronary heart disease), heart valve disease, or any other known heart abnormality, or if you have a disease called hypertrophic obstructive cardiomyopathy (also called HOCM, where the heart muscle is enlarged).

• If you have narrowing of the arteries (also called arteriosclerosis), if you have high blood pressure, or if you know you have an aneurysm (an abnormal bulge in the vascular wall).

• If you have heart rhythm disorders, such as increased heart rate or irregular heart rate, have an accelerated pulse, or suffer from palpitations, or have been informed that you have electrocardiographic abnormalities.

• If your thyroid gland is overactive.

• If your blood potassium level is low.

• If you have any liver or kidney disease.

• If you are diabetic (inhalation of high doses of formoterol may cause an increase in blood glucose levels and, therefore, you may need to undergo additional blood tests to control blood sugar when you start using the inhaler and from time to time during treatment).

• If you have a tumor of the adrenal glands (called pheochromocytoma).

• If you are going to receive anesthesia. Depending on the anesthetic agent, you may need to stop using Foster at least 12 hours before anesthesia.

• If you are going to be treated or have been treated for tuberculosis (TB) or if you have a known viral or fungal lung infection.

• If you cannot drink alcohol for any reason.

If any of the above applies to you, always inform your doctor before using Foster.

If you have or have had medical problems or allergies, or if you are not sure if you can use Foster, consult your doctor, nurse, or pharmacist before using the inhaler.

Treatment with a β2 agonist like the formoterol contained in Foster may cause a sudden drop in serum potassium levels (hypokalemia).

Be particularly careful if you have severe asthma.The reason is that a lack of oxygen in the blood and other treatments you may be receiving along with Foster, such as medications to treat heart disease or high blood pressure (known as diuretics) or other medications used to treat asthma, can worsen the drop in potassium levels. Therefore, your doctor will want to check your potassium level in the blood from time to time.

If you take higher doses of inhaled corticosteroids for prolonged periods, you may need corticosteroids in stressful situations. These situations include hospitalization after an accident, the existence of a severe injury, or before surgery. In such cases, the doctor treating you will decide if it is necessary to increase the dose of corticosteroids and may prescribe steroid tablets or injections.

In case you go to the hospital, remember to bring all your medications and inhalers, including Foster and other medications or tablets purchased without a prescription, preferably in their original packaging.

Contact your doctor if you experience blurred vision or other visual disturbances.

Children and adolescents

Foster should not be used in children and adolescents under 18 years of age until more data is available.

Other medicines and Foster

Tell your doctor if you are using or have recently used other medicines, including those purchased without a prescription.

Some medicines may increase the effects of Foster, so your doctor will monitor you closely if you are taking these medicines (including some for HIV: ritonavir, cobicistat).

Do not use beta-blockers with this medicine. If you need to use beta-blockers (including eye drops), the effect of formoterol may decrease or even be null. On the other hand, the use of other beta-adrenergic drugs (drugs that work in the same way as formoterol) may enhance the effects of formoterol.

The combined use of Foster with:

• Medicines for treating heart rhythm disorders (quinidine, disopyramide, procainamide), medicines for treating allergic reactions (antihistamines), medicines for treating symptoms of depression or mental disorders, such as monoamine oxidase inhibitors (e.g., phenelzine and isocarboxazid), tricyclic antidepressants (e.g., amitriptyline and imipramine), and phenothiazines, may lead to electrocardiographic abnormalities (ECG, electrocardiogram). They may also increase the risk of heart rhythm disorders (ventricular arrhythmias).

• Medicines for treating Parkinson's disease (L-dopa) or for treating an underactive thyroid gland (L-thyroxine), medicines containing oxytocin (which causes uterine contraction), and alcohol, may reduce cardiac tolerance to β2 agonists, such as formoterol.

• Monoamine oxidase inhibitors (MAOIs), including drugs with similar properties, such as furazolidone and procarbazine, used to treat mental disorders, may cause an increase in blood pressure.

• Medicines for treating heart disease (digoxin) may cause a drop in serum potassium levels. This may increase the likelihood of heart rhythm disorders.

• Other medicines used to treat asthma (theophylline, aminophylline, or steroids) and diuretics may cause a drop in serum potassium levels.

• Some anesthetics may increase the risk of heart rhythm disorders.

Pregnancy, breastfeeding, and fertility

There are no clinical data on the use of Foster during pregnancy.

Do not use Foster if you are pregnant or think you may be pregnant, if you plan to become pregnant, or if you are breastfeeding, unless your doctor advises you to do so.

Driving and using machines

The influence of Foster on the ability to drive and use machines is negligible.

Foster contains alcohol

Foster contains 7 mg of alcohol (ethanol) per puff, which is equivalent to 0.20 mg/kg per dose of two puffs. The amount in two puffs of this medicine is equivalent to less than 1 ml of wine or beer. The small amount of alcohol in this medicine does not produce any noticeable effect.

3. How to use Foster

Foster is for inhalation use only.

Follow the administration instructions for this medication exactly as indicated by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

Asthma

Your doctor will periodically review you to ensure that you are taking the optimal dose of Foster. Your doctor will always adjust the treatment to the minimum dose that best controls your symptoms.

Foster may be prescribed by your doctor in two different ways:

1. Use Foster daily to treat your asthma along with a separate "rescue" inhaler to treat sudden worsening of asthma symptoms, such as difficulty breathing, wheezing, and coughing
2. Use Foster daily to treat your asthma and also use Foster to treat sudden worsening of asthma symptoms, such as difficulty breathing, wheezing, and coughing

1. Using Foster with a separate "rescue" inhaler.

Adults and elderly patients:

The recommended dose of this medication is one to two puffs twice a day.

The maximum daily dose is 4 puffs.

Remember: You should always carry a rapid-acting "rescue" inhaler with you to treat worsening asthma symptoms or a sudden asthma attack.

1. Using Foster as the only inhaler for asthma:

Adults and elderly patients:

The recommended dose of this medication is one puff in the morning and one puff in the evening.

You should also use Foster as a "rescue" inhaler to treat sudden asthma symptoms.

If you have asthma symptoms, inhale one puff and wait a few minutes.

If you do not feel better, inhale another puff.

Do not inhale more than 6 rescue puffs per day.

The maximum daily dose of Foster is 8 puffs.

If you think you need more puffs per day to control your asthma symptoms, contact your doctor for advice. You may need to change your treatment.

Use in children and adolescents under 18 years:

Children and adolescents under 18 years of age SHOULD NOT take this medication.

COPD

Adults and elderly patients:

The recommended dose is two puffs in the morning and two puffs in the evening.

Patients at risk:

Elderly patients do not need to have their dose adjusted. There is no information available on the use of Foster in patients with liver or kidney problems.

Foster is effective for the treatment of asthma at a dose of beclometasone dipropionate that may be lower than that of other inhalers containing the same component. If you have previously been using another inhaler that contained beclometasone dipropionate, your doctor will advise you on the exact dose of Foster you should take for asthma.

Do not increase the dose.

If you think the medication is not very effective, always consult your doctor before increasing the dose.

If you use more Foster than you should

• If you use more formoterol than you should, you may experience the following adverse effects: nausea, vomiting, rapid heartbeat, palpitations, cardiac arrhythmias, certain electrocardiographic changes (heart signal), headache, tremors, drowsiness, excess acid in the blood, low potassium levels in the blood, and high glucose levels in the blood. Your doctor may request blood tests to check your potassium and glucose levels in the blood.
• Taking too much beclometasone dipropionate may cause short-term changes in the functioning of the adrenal glands. This situation will improve in a few days; however, your doctor may check your cortisol level in serum.

Consult your doctor if you experience any of these symptoms.

If you forget to use Foster

Take it as soon as you remember. If it is almost time for your next dose, do not take the missed dose; just take the next dose. Do not double the dose.

If you stop treatment with Foster

Do not decrease the dose or stop using the medication.

Even if you feel better, do not stop using Foster or decrease the dose. If you want to do so, consult your doctor. It is very important to use Foster regularly even if you do not have symptoms.

If your breathing difficulties increase:

If, immediately after inhaling the medication, your difficulty breathing or wheezing (audible whistling sound) worsens, stop using Foster immediately and use your rapid-acting inhaler right away. Contact your doctor quickly. Your doctor will evaluate the symptoms and, if necessary, modify the treatment. See also section 4 "Possible side effects".

If your asthma worsens:

If your symptoms worsen or you have difficulty controlling them (for example, if you increase the frequency of use of the separate rapid-acting inhaler or Foster as a rescue inhaler), or if the rapid-acting inhaler or Foster does not help improve your symptoms, go to the doctor immediately. Your asthma may be worsening, and your doctor may need to modify the dose of Foster or prescribe an alternative treatment.

If you have any other questions about the use of this product, ask your doctor or pharmacist.

Method of administration:

This medication is in a pressurized container inside a plastic casing with a mouthpiece.

There is a counter on the back of the inhaler, which indicates how many doses are left. Each time you press the container, a puff of medication is released, and the counter decrements one dose. Avoid dropping the inhaler, as this could cause the counter to decrement a dose.

Inhaler check

Before using the inhaler for the first time, or if you have not used it for 14 days or more, you must check your inhaler to ensure it is working correctly.

1. Remove the protective cap from the mouthpiece.
2. Hold the inhaler upright with the mouthpiece at the bottom.
3. Point the mouthpiece away from you and firmly pressthe container to release a dose.
4. Check the dose counter. If you are checking your inhaler for the first time, the counter should indicate 120.

How to use your inhaler

When possible, stand or sit upright to perform the inhalation.

1. Remove the protective cap from the mouthpiece and check that it is clean, i.e., that there are no dust, dirt, or other foreign particles.
2. Exhale slowly and deeply as much as possible.
3. Hold the container upright with the body upwards and place the mouthpiece between your lips. Do not bite the mouthpiece.
4. Inhale slowly and deeply through your mouth and, just as you start inhaling, firmly press the top of the inhaler to release a dose. If you have weakness in your hands, you may find it easier to hold the inhaler with both hands, placing your two index fingers on the top of the inhaler and your two thumbs on the bottom of the inhaler.
5. Hold your breath for as long as you can and finally remove the inhaler from your mouth and exhale slowly. Do not blow into the inhaler.

In case you need to inhale a new dose, hold the inhaler upright for about half a minute and then repeat steps 2 to 5.

Important: Do not perform steps 2 to 5 too quickly.

After administration, close with the protective cap and check the dose counter.

You should have a replacement inhaler when the counter shows the number 20. Stop using the inhaler when the counter reads 0, as even if there are puffs left in the device, they may not be enough to take a full dose.

If some of the gas escapes from the top of the inhaler or from the corner of your lips, it means that Foster is not going to reach your lungs as it should. Take another dose following the instructions, starting again from step 2.

To reduce the risk of fungal infection in the mouth and throat, rinse your mouth or gargle with water or brush your teeth each time you use the inhaler.

If you think the effect of Foster is too strong or insufficient, consult your doctor or pharmacist.

If you find it difficult to press the inhaler while starting to breathe in, you can use the AeroChamber Plus device. Consult your doctor, pharmacist, or nurse about using this device.

It is essential that you read the leaflet that comes with the AeroChamber Plus device and follow the instructions carefully on how to use the AeroChamber Plus device and how to clean it.

Cleaning

You should clean the inhaler once a week. When you clean it, do not remove the pressurized container from the device, and do not use water or other liquids to clean the inhaler.

To clean the inhaler:

1. Remove the mouthpiece cap from the inhaler.
2. Pass a clean, dry cloth or paper towel through the inside and outside of the mouthpiece and device.
3. Put the mouthpiece cap back on.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

As with other inhaler treatments, there is a risk of worsening breathing difficulties and wheezing immediately after using Foster, which is known as paradoxical bronchospasm. If this happens, STOP using Fosterand use your rapid-acting inhaler right away to treat breathing difficulty and wheezing symptoms. Contact your doctor immediately.

Tell your doctor immediately if you experience hypersensitivity reactions, such as skin allergies, itching, rash, redness, swelling of the skin or mucous membranes, especially in the eyes, face, lips, and throat.

Other side effects are listed below by frequency.

Frequent(at least 1 in 10 patients):

Fungal infections (of the mouth and throat), headache, hoarseness, sore throat.

Pneumonia (lung infection) in patients with COPD: inform your doctor if you have any of the following symptoms while inhaling Foster; they could be symptoms of a lung infection:

• Fever or chills
• Increased production of mucus, change in the color of mucus
• Increased coughing or increased breathing difficulties

Uncommon(at least 1 in 100 patients):

Palpitations, exceptionally fast heartbeat, and cardiac arrhythmias, certain electrocardiographic changes (ECG).

Flu-like symptoms, vaginal fungal infections, sinusitis (inflammation of the paranasal sinuses), rhinitis, ear inflammation, throat irritation, cough, and productive cough, asthma attacks.

Nausea, alterations or decrease in taste, burning of the lips, dry mouth, difficulty swallowing, indigestion, stomach upset, diarrhea.

Muscle pain and cramps, flushing, increased blood flow in certain tissues of the body, excessive sweating, tremors, restlessness, dizziness, rash or hives.

Changes in certain blood components: decreased white blood cell count, increased platelet count, decreased potassium levels in the blood, increased glucose levels in the blood, increased insulin levels, free fatty acids, and ketones in the blood.

The following side effects have also been reported as "uncommon" in patients with Chronic Obstructive Pulmonary Disease.

• Decreased cortisol levels in the blood; this is caused by the effect of corticosteroids on your adrenal gland.
• Irregular heartbeats.

Rare(at least 1 in 1,000 patients)

Chest tightness, feeling of missed heartbeats (due to premature contraction of the heart ventricles), increased or decreased blood pressure, kidney inflammation, persistent swelling of the skin and mucous membranes for several days.

Very rare(at least 1 in 10,000 patients)

Breathing difficulties, worsening of asthma, decreased platelet count, swelling of the hands and feet.

Unknown

Blurred vision

Inhaling corticosteroids at high doses for a prolonged period may cause systemic effects in very rare cases:these include problems with the functioning of the adrenal glands (suppression of adrenal function), decreased bone density (weakening of bones), growth retardation in children and adolescents, increased intraocular pressure (glaucoma), cataracts.

Sleep disorders, depression, or feeling worried, restless, nervous, overexcited, or irritable: these effects may occur especially in children, but their frequency is unknown.

Reporting of side effects

If you experience any side effects, consult your doctor or pharmacist or nurse, even if they are possible side effects not listed in this leaflet. You can also report them directly through the Spanish Medicines and Healthcare Products Agency (AEMPS) https://www.notificaram.es.

By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Foster

Keep this medicine out of the sight and reach of children.

Single pack containing 1 inhaler of 120 doses

Do not use Foster after 3 months from the date it was dispensed by your pharmacist and never use it after the expiration date shown on the box and label. Do not store the inhaler at a temperature above 25°C.

Double pack containing 2 inhalers of 120 doses

Before use: Store the inhaler in the refrigerator (at 2-8°C).

After first use: Use the inhaler for a maximum of 3 months and do not store at a temperature above 25°C. Do not use the inhaler after this period and never use it after the expiration date shown on the box and label. Do not freeze.

If the inhaler has been exposed to intense cold, warm it up with your hands for a few minutes before use. Never heat it artificially.

Warning: The container contains a pressurized liquid. Do not expose the container to temperatures above 50°C. Do not puncture the container.

Medicines should not be disposed of via wastewater or household waste. Place the packaging and any unused medication in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and any unused medication. This will help protect the environment.

6. Package contents and additional information

Foster composition

• The active ingredients are: beclometasone dipropionate, formoterol fumarate dihydrate.

Each puff of the dosing valve contains 100 micrograms of beclometasone dipropionate and 6 micrograms of formoterol fumarate dihydrate. This corresponds to a delivered dose from the mouthpiece of 84.6 micrograms of beclometasone dipropionate and 5.0 micrograms of formoterol fumarate.

• The other ingredients are: anhydrous ethanol, hydrochloric acid, propellant: norflurane (HFC-134a). This medicine contains fluorinated greenhouse gases. Each inhaler contains 8.147 g of norflurane (HFC-134a), which corresponds to 0.012 tons of CO2 equivalent (global warming potential GWP = 1430).

Product appearance and package contents

Foster is a pressurized solution contained in an aluminum-coated container with a dosing valve, equipped with a plastic polypropylene actuator with a protective cap.

Each pack contains a container that provides 120 puffs.

Only some pack sizes may be marketed.

Marketing authorization holder:

Chiesi Spain S.A.U.

Plaça d’Europa, 41-43, Planta 10

08908 L'Hospitalet de Llobregat - Barcelona (Spain)

Manufacturer and batch release responsible:

Chiesi Farmaceutici S.p.A.

Via San Leonardo 96

43122 Parma - Italy

or

Chiesi Pharmaceuticals GmbH

Gonzagagasse 16/16

Vienna – 1010 - Austria

or

Chiesi S.A.S.

2 rue des Docteurs Alberto et Paolo Chiesi

41260 La Chaussée Saint-Victor

France

This medicine is authorized in the following Member States of the European Economic Area and in the United Kingdom (Northern Ireland) under the following trademarks:

Austria: Foster

France: Innovair

Germany: Kantos

Greece: Foster

Hungary: Foster

Italy: Foster

Spain: Foster

Czech Republic: Combair

Slovak Republic: Foster

Poland: Fostex

Portugal: Foster

Slovenia: Foster

Netherlands: Foster

United Kingdom: Fostair

Date of last revision of this leaflet:November 2023

Detailed information on this medicine is available on the website of the Spanish Agency for Medicines and Healthcare Products (AEMPS) http://www.aemps.gob.es.