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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Inhaled Corticosteroid Dose Comparison in Asthma
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