Inhaled Corticosteroid Dose Comparison in Asthma

The chart below provides inhaled corticosteroid dose comparisons based on clinical trials in asthma without a spacer. Consider extent of control and disease severity when switching. Doses are approximate; monitor response closely and adjust dose as appropriate. Some information may differ from U.S. prescribing information.

Abbreviations: DPI=dry powder inhaler; HFA=hydrofluoroalkane.

  1. Based on references 1, 6, and 12 unless otherwise denoted.
  2. Arnuity Ellipta and Breo Ellipta are dosed once daily. Asmanex Twisthaler is dosed once daily, except at the 880 mcg/day dose (divided twice daily). Pulmicort Respules are recommended for once or twice daily dosing. Product labeling for other products recommends twice daily dosing. Symbicort, Advair HFA, and Dulera labeling recommend administering as two puffs twice daily.

Medication/strengths available

Comparative Daily Dosesa,b

12 yrs and older
Low Range

12 yrs and older
Medium Range

12 yrs and older
High Dose

5 to 11 yrs
Low Range

5 to 11 yrs
Medium Range

5 to 11 yrs
High Dose

Beclomethasone HFA
(QVAR)

40 mcg/inhalation, 80 mcg/inhalation

80 mcg to 240 mcg

280 mcg to 480 mcg

(Max FDA-approved dose for age ≥12 yrs is 320 mcg twice daily.2)

>480 mcg

(Max FDA-approved dose for age ≥12 yrs is 320 mcg twice daily.2)

80 mcg to 160 mcg

200 mcg to 320 mcg

(Max FDA-approved dose for ages 5 to 11 yrs is 80 mcg twice daily.2)

>320 mcg

(Max FDA-approved dose for ages 5 to 11 yrs is 80 mcg twice daily.2)

Budesonide DPI
(Pulmicort Flexhaler)

90 mcg/inhalation, 180 mcg/inhalation

360 mcg to 540 mcg

630 mcg to 1170 mcg

(Max FDA-approved dose for ages 6 to 17 yrs is 360 mcg twice daily.3)

>1200 mcg

(Max FDA-approved dose for ages 6 to 17 yrs is 360 mcg twice daily, and 720 mcg twice daily for ages 18 yrs and older.3)

360 mcg

(FDA-approved for children 6 to 17 yrs of age.3)

450 mcg to720 mcg

(FDA-approved for children 6 to 17 yrs of age.3)

>800 mcg

(FDA-approved for ages 6 to 17 yrs. Max dose 360 mcg twice daily.3)

Budesonide nebulizer suspension
(Pulmicort Respules)

0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

FDA approved for children 12 mos to 8 yrs of age.4

FDA approved for children 12 mos to 8 yrs of age.4

FDA approved for children 12 mos to 8 yrs of age.4

0.5 mg

(FDA approved for children 12 mos to 8 yrs of age.4)

1 mg

(FDA approved for children 12 mos to
8 yrs of age.4)

2 mg

(FDA-approved for children 12 mos to 8 yrs of age. Max dose 1 mg.4)

Budesonide/formoterol HFA
(Symbicort)

80/4.5 mcg or 160/4.5 mcg per inhalation

320/18 mcg15

320/18 mcg to 640/18 mcg15

640/18 mcg15

FDA approved dose in children 6 to 12 yrs of age is 160 mcg/9 mcg twice daily.15

FDA approved dose in children 6 to 12 yrs of age is 160 mcg/9 mcg twice daily.15

FDA approved dose in children 6 to 12 yrs of age is 160 mcg/9 mcg twice daily.15

Ciclesonide HFA
(Alvesco)

80 mcg/inhalation, 160 mcg/inhalation

160 mcg

240 mcg to 320 mcg

>320 mcg

(Max dose 320 mcg twice daily.5)

FDA-approved only for age ≥12 yrs.5

FDA-approved only for age ≥12 yrs.5

FDA-approved only for age ≥12 yrs.5

Flunisolide HFA
(Aerospan)

80 mcg/inhalation

320 mcg

400 mcg to 640 mcg

>640 mcg

(Max FDA-approved dose for age ≥12 yrs is 320 mcg twice daily.7)

160 mcg

320 mcg

(FDA-approved for children 6 to 11 yrs of age.7)

≥640 mcg

(FDA-approved for children 6 to 11 yrs of age. Max dose 160 mcg twice daily.7)

Fluticasone furoate DPI
(Arnuity Ellipta)

100 mcg/blister, 200 mcg/blister

100 mcg

N/A

200 mcg

Not FDA-approved for children <12 yrs of age.16

Not FDA-approved for children <12 yrs of age.16

Not FDA-approved for children <12 yrs of age.16

Fluticasone furoate/vilanterol DPI
(Breo Ellipta)

100/25 mcg or 200/25 mcg per blister

100/25 mcg

(FDA-approved only for adults age 18 and older.17)

N/A

200/25 mcg (FDA-approved only for adults age 18 and older.17)

FDA-approved only for adults age 18 and older.17

FDA-approved only for adults age 18 and older.17

FDA-approved only for adults age 18 and older.17

Fluticasone propionate HFA
(Flovent-HFA)

44 mcg/inhalation, 110 mcg/inhalation, 220 mcg/inhalation

176 mcg

264 mcg to 440 mcg

>440 mcg

(Max FDA-approved dose for age ≥12 yrs is 880 mcg twice daily.8)

176 mcg

(FDA-approved for children 4 to 11 yrs of age.8)

220 mcg to 352 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 88 mcg twice daily.8)

>352 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 88 mcg twice daily.8)

Fluticasone propionate/salmeterol HFA
(Advair HFA)

45/21 mcg, 115/21 mcg, or 230/21 mcg per inhalation

180/84 mcg to 250/84 mcg

320/84 mcg to 460/84 mcg

>460/84 mcg

(Max FDA-approved dose for age ≥12 yrs is 460/42 mcg twice daily.11)

Not FDA-approved for children <12 yrs of age.11

Not FDA-approved for children <12 yrs of age.11

Not FDA-approved for children <12 yrs of age.11

Fluticasone propionate/salmeterol DPI
(Advair Diskus)

100/50 mcg, 250/50 mcg, or 500/50 mcg per blister

200/100 mcg

350/100 mcg to 500/100 mcg

>500/50 mcg

(Max FDA-approved dose for age ≥12 yrs is 500/50 mcg twice daily.13)

200/100 mcg

(FDA-approved for children 4 to 11 yrs of age at a dose of 100/50 mcg twice daily.13)

>200/100 mcg to 350/100 mcg

(FDA-approved for children 4 to 11 yrs of age at a dose of 100/50 mcg twice daily.13)

≥500/50 mcg

(FDA-approved for children 4 to 11 yrs of age at a dose of
100/50 mcg twice daily.13)

Fluticasone propionate/salmeterol DPI
(Airduo Respiclick)c

55/14 mcg, 113/14 mcg, or 232/14 mcg per inhalation

110/28 mcg18

226/28 mcg18

464/28 mcg18

Not FDA-approved for children <12 yrs of age.18

Not FDA-approved for children <12 yrs of age.18

Not FDA-approved for children <12 yrs of age.18

Fluticasone propionate DPI
(Armonair Respiclick)

55 mcg, 113 mcg, or 232 mcg per inhalation

110 mcg19

226 mcg19

464 mcg19

Not FDA-approved for children <12 yrs of age.19

Not FDA-approved for children <12 yrs of age.19

Not FDA-approved for children <12 yrs of age.19

Fluticasone propionate DPI
(Flovent Diskus)

50 mcg/blister, 100 mcg/blister, 250 mcg/blister

200 mcg to 300 mcg

350 mcg to 500 mcg

>500 mcg

(Max FDA-approved dose for age ≥12 yrs is 1000 mcg twice daily.9)

100 mcg to 200 mcg

(FDA-approved for children 4 to 11 yrs of age.9)

>200 mcg to 400 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 100 mcg twice daily.9)

>400 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 100 mcg twice daily.9)

Mometasone DPI
(Asmanex Twisthaler)

110 mcg/inhalation, 220 mcg/inhalation

220 mcg

330 mcg to 440 mcg

>440 mcg

(Max FDA-approved dose for age ≥12 yrs is 440 mcg twice daily.10)

110 mcg

(FDA-approved for children 4 to 11 yrs of age.10)

220 mcg to <440 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 110 mcg once daily.10)

≥440 mcg

(Max FDA-approved dose for children 4 to 11 yrs of age is 110 mcg once daily.10)

Mometasone/Formoterol HFA
(Dulera)

100/5 mcg or 200/5 mcg per inhalation

N/A

400/20 mcg14

800/20 mcg14

Not FDA-approved for children <12 yrs of age.14

Not FDA-approved for children <12 yrs of age.14

Not FDA-approved for children <12 yrs of age.14

c. Authorized generic available for Airduo.

Project Leader in preparation of this clinical resource (330402): Melanie Cupp, Pharm.D., BCPS; last modified June 2017.

References

  1. Kelly HW. Comparison of inhaled corticosteroids: an update. Ann Pharmacother 2009;43:519-27.
  2. Product information for QVAR. Teva Specialty Pharmaceuticals LLC. Horsham, PA 19044. July 2014.
  3. Product information for Pulmicort Flexhaler. AstraZeneca LP. Wilmington, DE 19850. October 2016.
  4. Product information for Pulmicort Respules. AstraZeneca LP. Wilmington, DE 19850. November 2016.
  5. Product information for Alvesco. Sunovion Pharmaceuticals Inc. Marlborough, MA 01752. January 2013.
  6. Global Initiative for Asthma. Global strategy for asthma management and prevention. Revised 2017. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/ (Accessed March 6, 2017).
  7. Product information for Aerospan. Meda Pharmaceuticals. Somerset, NJ 08873. June 2015.
  8. Product information for Flovent-HFA. GlaxoSmithKline. Research Triangle Park, NC 27709. September 2016.
  9. Product information for Flovent Diskus. GlaxoSmithKline. Research Triangle Park, NC 27709. September 2016.
  10. Product information for Asmanex Twisthaler. Merck & Co., Inc. Whitehouse Station, NJ 08889. September 2014.
  11. Product information for Advair HFA. GlaxoSmithKline. Research Triangle Park, NC 27709. December 2014.
  12. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program, expert panel report 3. Summary report 2007. Guidelines for the diagnosis and management of asthma. http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf. (Accessed February 27, 2017).
  13. Product information for Advair Diskus. GlaxoSmithKline. Research Triangle Park, NC 27709. April 2016.
  14. Product information for Dulera. Merck & Co., Inc. Whitehouse Station, NJ 08889. July 2016.
  15. Product information for Symbicort. AstraZeneca LP. Wilmington, DE 19850. January 2017.
  16. Product information for Arnuity Ellipta. GlaxoSmithKline. Research Triangle Park, NC 27709. November 2014.
  17. Product information for Breo Ellipta. GlaxoSmithKline. Research Triangle Park, NC 27709. May 2017.
  18. Product information for Airduo Respiclick. Teva Respiratory, LLC. Frazer, PA 19355. January 2017.
  19. Product information for Armonair Respiclick. Teva Respiratory, LLC. Frazer, PA 19355. January 2017.

Cite this document as follows: Clinical Resource, Inhaled Corticosteroid Dose Comparison in Asthma. Pharmacist’s Letter/Prescriber’s Letter. April 2017.

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