Inhaled Corticosteroid Dose Comparison in Asthma

BDP = Beclometasone dipropionate; ICS = Inhaled corticosteroid; LABA = Long-acting beta-agonist; MDI = Metered dose inhaler; DPI = Dry powder inhaler

Qvar® has extrafine particles, and is more potent than traditional BDP CFC-containing inhalers; Qvar® is approximately twice as potent as Clenil® Modulite®.

Fostair® (MDI), Fostair® NEXThaler® (DPI) and Trimbow® (MDI) 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 (2016). 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.

Very low dose (for use in children)

200 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Clenil® Modulite® (MDI) 50 micrograms - 2 puffs twice a day
Budesonide
  • Pulmicort® Turbohaler® (DPI) 100 micrograms - 1 puff twice a day

Combination ICS/LABA inhalers

Budesonide / formoterol
  • Symbicort® Turbohaler® (DPI) 100/6 - 1 puff twice a day

Low dose

400 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Clenil® Modulite® (MDI) 100 micrograms - 2 puffs twice a day
  • Qvar® (MDI or breath actuated aerosol) (extrafine) 50 micrograms - 2 puffs twice a day
Budesonide
  • Pulmicort® Turbohaler® (DPI)
    • 100 micrograms – 2 puffs twice a day
    • 200 micrograms - 1 puff twice a day

Combination ICS/LABA inhalers

Budesonide / formoterol
  • Duoresp® Spiromax® (DPI) 160/4.5 - 1 puff twice a day
    • Note: DuoResp Spiromax® is licensed for use in adults aged 18 years and above
  • Symbicort® Turbohaler® (DPI)
    • 100/6 - 2 puffs twice a day
    • 200/6 - 1 puff twice a day
    • Note: Symbicort® Turbohaler® 100/6 is licensed for use in adults, adolescents and children aged 6 years and above
    • Note: Symbicort® Turbohaler® 200/6 is licensed for use in adults and adolescents aged 12 years and above
Fluticasone propionate /salmeterol
  • Seretide® Evohaler® (MDI) 50/25 - 2 puffs twice a day
  • Note: Seretide® Evohaler® 50/25 is included in the formulary for use in children only)
  • Seretide® Accuhaler® (DPI) 100/50 - 1 puff twice a day

500 micrograms BDP equivalent per day

Combination ICS/LABA inhalers

Beclometasone dipropionate (extrafine) / formoterol
  • Fostair® (MDI) / Fostair® NEXThaler® (DPI) 100/6 - 1 puff twice a day
  • Note: Fostair® and Fostair® NEXThaler® are licensed for use in adults aged 18 years and above

Medium dose

Medium dose ICS should only be used in children aged 12 years and under after referring the patient to secondary care.

800 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Clenil® Modulite® (MDI) 200 micrograms - 2 puffs twice a day
  • Qvar® (MDI or breath actuated aerosol) (extrafine) 100 micrograms – 2 puffs twice a day
Budesonide
  • Pulmicort® Turbohaler® (DPI)
    • 200 micrograms - 2 puffs twice a day
    • 400 micrograms – 1 puff twice a day

Combination ICS/LABA inhalers

Budesonide / formoterol
  • Duoresp® Spiromax® (DPI)
    • 160/4.5 - 2 puffs twice a day
    • 320/9 - 1 puff twice a day
    • Note: DuoResp® Spiromax® is licensed for use in adults aged 18 years and above
  • Symbicort® Turbohaler® (DPI)
    • 200/6 - 2 puffs twice a day
    • 400/12 - 1 puff twice a day
    • Note: Symbicort® Turbohaler® 200/6 and 400/12 are licensed for use in adults and adolescents aged 12 years and older

1000 micrograms BDP equivalent per day

Combination ICS/LABA inhalers

Beclometasone dipropionate (extrafine) / formoterol
  • Fostair® (MDI) / Fostair® NEXThaler® (DPI) 100/6 - 2 puffs twice a day
    • Note: Fostair® and Fostair® NEXThaler® are licensed for use in patients aged 18 years and above
Fluticasone furoate / vilanterol
  • Relvar® Ellipta® (DPI) 92/22 – 1 puff once a day
    • Note: BTS/SIGN classify Relvar® Ellipta® 92/22 as a low to medium dose ICS
    • Note: Relvar® Ellipta® is licensed for use in adults and adolescents aged 12 years and above
Fluticasone propionate/ Salmeterol
  • Airflusal® (MDI) 125/25 – 2 puffs twice a day
    • Note: AirFluSal® is licensed for use in adults aged 18 years and above
  • Seretide® Accuhaler® (DPI) 250/50 - 1 puff twice a day
    • Note: This dose is only licensed for use in adults and children aged 12 years and older

High dose (for use in adults)

High dose ICS should only be used after referring the patient to secondary care.

High dose MDI inhaled corticosteroid devices should be prescribed with a spacer to reduce risk of oral candidiasis.

1000 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Clenil® Modulite® (MDI) 250 micrograms - 2 puffs twice a day

1600 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Qvar® (MDI or breath actuated aerosol) (extrafine) 100 micrograms – 4 puffs twice a day
Budesonide
  • Pulmicort® Turbohaler® (DPI) 400 micrograms – 2 puffs twice a day

Combination ICS/LABA inhalers

Budesonide / formoterol
  • Duoresp® Spiromax® (DPI) 320/9 - 2 puffs twice a day
  • Symbicort® Turbohaler® (DPI) 400/12 - 2 puffs twice a day

2000 micrograms BDP equivalent per day

ICS monotherapy inhaler

Beclometasone dipropionate
  • Clenil® Modulite® (MDI) 250 micrograms - 4 puffs twice a day

Combination ICS/LABA inhalers

Beclometasone dipropionate (extrafine) / formoterol
  • Fostair® (MDI) / Fostair® NEXThaler® (DPI) 200/6 - 2 puffs twice a day
Fluticasone furoate / vilanterol
  • Relvar® Ellipta® (DPI) 184/22 – 1 puff once a day
Fluticasone propionate / salmeterol
  • Airflusal® (MDI) 250/25 – 2 puffs twice a day
  • Seretide® Accuhaler® (DPI) 500/50 - 1 puff twice a day

 

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