All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Page last updated:
7 March 2022
BDP = Beclometasone dipropionate; ICS = Inhaled corticosteroid; LABA = Long-acting beta-agonist; pMDI = Pressurised metered dose inhaler; BAI = Breath actuated (aerosol) inhaler; DPI = Dry powder inhaler
Kelhale and Qvar have extrafine BDP particles, and are more potent than traditional BDP CFC-containing inhalers; Kelhale and Qvar are approximately twice as potent as Clenil Modulite.
Fostair (pMDI), Fostair NEXThaler (DPI) and Luforbec (pMDI) have extrafine particles. The manufacturer states that 100 micrograms of BDP extrafine in these preparations is equivalent to 250 micrograms of BDP in a non-extrafine formulation.
Relvar Ellipta (DPI): fluticasone furoate in Relvar Ellipta has a higher potency compared to fluticasone propionate used in some other products; doses are not interchangeable. The manufacturer's summary of product characteristics (SPC) states that in patients with asthma, fluticasone furoate 100 micrograms once daily is approximately equivalent to fluticasone propionate 250 micrograms twice daily.
The dosage equivalents shown below are approximate and will depend on other factors such as inhaler technique. The very low, low, medium and high dose ICS categories have been taken from the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidance Network (SIGN) British guideline on the management of asthma (2019). Doses are presented in comparison to standard BDP equivalency per day.
Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant summary of product characteristics (SPC) should be checked.
The NHS Devon Medicines Optimisation Team has produced additional resources to support greener respiratory care across Devon (see here).
Medium dose ICS should only be used in children aged 12 years and under after referring the patient to secondary care.
Note: BTS/SIGN classify BDP 1000 micrograms equivalent/day as a high dose corticosteroid when given as Clenil Modulite but a medium dose corticosteroid when given as BDP extrafine in combination with formoterol as Fostair NEXThaler.
High dose ICS should only be used after referring the patient to secondary care.
High dose pMDI inhaled corticosteroid devices should be prescribed with a spacer to reduce risk of oral candidiasis.
Note: BTS/SIGN classify BDP 1000 micrograms equivalent/day as a high dose corticosteroid when given as Clenil Modulite but a medium dose corticosteroid when given as BDP extrafine in combination with formoterol as Fostair NEXThaler.