Asthma Treatments: Inhalations
| ASTHMA TREATMENTS: INHALATIONS | |||||
|---|---|---|---|---|---|
| Brand & Company | Generic | Strength | Formu- lations |
Class | Dosage |
| ADVAIR DISKUS
(GlaxoSmithKline) |
fluticasone propionate
+ salmeterol |
100/50
250/50 500/50 (mcg) |
dry pwd | steroid
+ long-acting β2-agonist |
<4yrs: not recommended.
4–11yrs: 1 inh of 100/50 twice daily. ≥12yrs: initially 1 inh of 100/50 or 250/50 twice daily; max 1 inh of 500/50 twice daily. |
| ADVAIR HFA
(GlaxoSmithKline) |
45/21
115/21 230/21 (mcg) |
MDI | <12yrs: not recommended.
≥12yrs: not currently on inhaled steroid: 2 inh 45/21 or 115/21 twice daily. Already on inhaled steroid: see literature. Max 2 inh 230/21 twice daily. |
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| Albuterol
(various) |
albuterol sulfate | 0.5% | soln | β2-agonist | Children: use other forms
Adults: use nebulizer. 2.5mg 3–4 times daily. |
| 0.083% | soln | <4yrs: not recommended.
≥4yrs: 2 inh every 4–6 hrs as needed; 1 inh every 4 hrs may suffice. EIB*: 2 inh 15 mins before exercise |
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| 90mcg | MDI | ||||
| ALUPENT
(Boehringer Ingelheim) |
metaproterenol sulfate | 0.65mg | MDI | β2-agonist | Children: not recommended.
Adults: 2–3 inh every 3–4 hrs; max 12 inh daily. |
| 0.4%
0.6% |
soln | Children: not recommended.
Adults: use intermittent positive pressure breathing apparatus (IPPB): 2.5mL 3–4 times daily; up to every 4 hrs. |
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| ALVESCO
(Sunovion) |
ciclesonide | 80mcg
160mcg |
MDA | steroid | Children: not recommended
Adults: previously on bronchodilators alone: initially 80mcg twice daily, max 160mcg twice daily. Previously on inhaled corticosteroids: initially 80mcg twice daily; max 320mcg twice daily. Previously on oral corticosteroids (see literature): 320mcg twice daily. Rinse mouth after use; avoid eyes. |
| ASMANEX TWISTHALER
(Merck) |
mometasone furoate | 110mcg
220mcg |
dry pwd | steroid | <4yrs: not recommended.
4–11yrs: 110mcg once in PM; max 110mcg/day. ≥12yrs: previously on bronchodilators alone or inhaled steroids: Initially 220mcg once in PM; max 440mcg/day (as 2 inh once daily or 1 inh twice daily). Previously on oral steroids: Initially 440mcg twice daily; max 880mcg/day. |
| ATROVENT HFA
(Boehringer Ingelheim) |
ipratropium bromide | 17mcg | MDI | anticholinergic | Children: not recommended.
Adults: 2 inh 4 times daily; max 12 inh/day. |
| —
(various) |
0.02% | soln | Children: not recommended.
Adults: 500micrograms orally by nebulization 3–4 times daily; separate doses by 6–8 hrs. |
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| Cromolyn
(various) |
cromolyn sodium | 20mg/2mL | soln | mast cell stabilizer | <2yrs: not recommended.
≥2yrs: use nebulizer. 20mg 4 times a day. |
| DULERA
(Merck) |
mometasone furoate
+ formoterol fumarate |
100/5
200/5 (mcg) |
MDI | steroid
+ long-acting β2-agonist |
Children: not recommended.
Adults: Previously on medium dose of steroid: use 100/5; previously on high dose of steroid: use 200/5. For both: Two inhalations twice daily. |
| FLOVENT DISKUS
(GlaxoSmithKline) |
fluticasone propionate |
50mcg
100mcg 250mcg |
dry pwd | steroid | <4yrs: not recommended.
4–11yrs: Previously on bronchodilators alone or on inhaled corticosteroids: initially 50mcg twice daily; max 100mcg twice daily. ≥11yrs: Previously on bronchodilators alone: initially 100mcg twice daily; max 500mcg twice daily. Previously on inhaled corticosteroids: initially 100–250mcg twice daily; max 500mcg twice daily. Previously on oral corticosteroids (wean gradually): initially 500–1000mcg twice daily; max 1000mcg twice daily. |
| FLOVENT HFA
(GlaxoSmithKline) |
fluticasone propionate |
44mcg
110mcg 220mcg |
MDI | steriod | <4yrs: not recommended.
4–11yrs: 88 mcg twice daily. ≥12yrs: previously on bronchodilators alone: Initially 88mcg twice daily; max: 440mcg twice daily. Previously on inhaled steroids: Initially 88–220mcg twice daily; max 440mcg twice daily. Previously on oral steroids: Initially 440mcg twice daily; max 880mcg twice daily. |
| FORADIL AEROLIZER
(Merck) |
formoterol fumarate | 12mcg | dry pwd | long-acting β2-agonist |
Asthma Maintenance
<5yrs: not recommended ≥5yrs: 1 inh every 12 hrs; max 1 inh twice daily. Prevention of EIB* ≥5yrs: 1 inh at least 15mins before exercise; max 1 inh/12 hrs. |
| Brand & Company | Generic | Strength | Formu- lations |
Class | Dosage |
| MAXAIR AUTOHALER
(Medicis) |
pirbuterol acetate | 200mcg | MDI | β2-agonist | Children: not recommended.
Adults: 1–2 inh every 4–6 hrs; max 12 inh/day. |
| Metaproterenol
(various) |
metaproterenol sulfate | 5% | soln | β2-agonist | <6yrs: not recommended.
6–12yrs: use nebulizer. 0.1–0.2mL 3–4 times daily, up to every 4 hrs. ≥12yrs: 3–4 times daily (see literature). |
| PROAIR HFA
(Teva) |
albuterol sulfate | 90mcg | MDA | β2-agonist | Prevention & Treatment
<4yrs: not recommended ≥4yrs: 2 inh every 4–6 hrs; 1 inh every 4 hrs may suffice. Prevention of EIB* ≥4yrs: 2 inh 15–30mins before exercise. |
| PROVENTIL HFA
(Merck) |
MDA | Prevention & Treatment
<4yrs: use other forms. ≥4yrs: 2 inh every 4–6 hrs; 1 inh every 4 hrs may suffice. Prevention of EIB* ≥4yrs: 2 inh 15–30mins before exercise. |
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| PULMICORT FLEXHALER
(AstraZeneca) |
budesonide | 90mcg 180mcg |
dry pwd | steroid | <6yrs: not recommended.
6–17yrs: initially 180mcg twice daily; may consider starting at 360mcg twice daily; max 360mcg twice daily. ≥18yrs: initially 360mcg twice daily; 180mcg twice daily may suffice; max 720mcg twice daily. |
| PULMICORT RESPULES
(AstraZeneca) |
0.25mg/2mL
0.5mg/2mL 1mg/2mL |
susp | <6months: not recommended
6–12months: see literature. 12months–8yrs: previously on bronchodilators alone: 0.5mg/day once daily or in 2 divided doses. Previously on inhaled corticosteroids: 0.5mg/day once daily or in 2 divided doses; max 1mg/day. Previously on oral corticosteroids: 1mg/day once daily or in 2 divided doses. Adults: use Flexhaler. |
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| QVAR
(Teva) |
beclomethasone diproprionate | 40mcg
80mcg |
MDI | steroid | <5yrs: not recommended.
≥5–11yrs: initially 40mcg twice daily; max 80mcg twice daily. Adults: previously on bronchodilators alone: Initially 40–80mcg twice daily; previously on inhaled corticosteroids: Initially 40–160mcg twice daily. Max 320mcg twice daily. |
| SEREVENT DISKUS
(GlaxoSmithKline) |
salmeterol xinafoate | 50mcg | dry pwd | long-acting
β2-agonist |
Asthma
<4yrs: not recommended. ≥4yrs: 1 inh twice daily. Prevention of EIB* ≥4yrs: 1 inh at least 30mins before exercise; max 2 doses/day. |
| SYMBICORT
(AstraZeneca) |
budesonide
+ formoterol fumarate dihydrate |
80/4.5
160/4.5 (mcg) |
MDI | steroid
+ long-acting β2-agonist |
For all: 2 inh twice daily (AM & PM). (see literature) |
| VENTOLIN HFA
(GlaxoSmithKline) |
albuterol sulfate | 90mcg | MDA | β2-agonist | Prevention & Treatment
<4yrs: not recommended. ≥4yrs: 2 inh every 4–6 hours; 1 inh every 4 hours may suffice. Prevention of EIB* ≥4yrs: 2 inh 15–30mins before exercise. |
| XOPENEX
(Sunovion) |
levalbuterol HCl | 0.31mg/3mL
0.63mg/3mL 1.25mg/3mL |
soln | β2-agonist | <6 yrs: not recommended.
6–11 yrs: 0.31mg by nebulization 3 times daily; max 0.63mg 3 times daily. >12yrs: initially 0.63mg 3 times daily at 6–8 hrs intervals; may increase to 1.25mg 3 times daily. |
| XOPENEX CONCENTRATE
(Sunovion) |
1.25mg/0.5mL | ||||
| XOPENEX HFA
(Sunovion) |
levalbuterol tartrate | 45mcg | MDI | Prevention & Treatment
<4yrs: not recommended. ≥4yrs: 2 inh every 4–6 hours; 1 inh every 4 hours may suffice. |
|
| NOTES | |||||
|
dry pwd = dry powder for inhalation; MDI = metered-dose inhaler; soln = solution for inhalation; MDA = metered dose aerosol; susp = suspension for inhalation *EIB = exercise induced bronchospasm (Rev. 5/2013) |
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