Asthma Treatments: Inhalations

ASTHMA TREATMENTS: INHALATIONS
ASTHMA TREATMENTS: INHALATIONS
Generic Brand Strength Form Dosage
ANTICHOLINERGIC
ipratropium bromide 0.02% soln Children: Not recommended.
Adults: 500mcg orally by nebulization 3−4 times daily; separate doses by 6−8hrs.
Atrovent HFA 17mcg MDI Children: Not established.
Adults: 2 inh 4 times daily; max 12 inh/day.
tiotropium bromide monohydrate Spiriva Respimat 1.25mcg, 2.5mcg soln Children: Not established.
Adults: 2 inh of 1.25mcg/actuation (2.5mcg) once daily.
BETA2-AGONIST
albuterol sulfate 0.5% soln Children: Use other forms.
Adults: Use nebulizer. 2.5mg 3−4 times daily.
0.083% soln <4yrs: Not recommended.
≥4yrs: Bronchospasm: 2 inh every 4−6hrs as needed; 1 inh every 4hrs may suffice.
EIB: 2 inh 15min before exercise.
90mcg MDI
ProAir HFA 90mcg MDA <4yrs: Not established.
≥4yrs: Bronchospasm: 2 inh every 4−6hrs; 1 inh every 4hrs may suffice.
EIB: 2 inh 15−30min before exercise.
ProAir RespiClick 90mcg dry 
pwd
<4yrs: Not established.
≥4yrs: Bronchospasm: 2 inh every 4−6hrs; in some patients: 1 inh every 4hrs may suffice.
EIB: 2 inh 15−30min before exercise.
Proventil HFA 90mcg MDA <4yrs: Not established.
Ventolin HFA 90mcg MDA ≥4yrs: Bronchospasm: 2 inh every 4−6hrs as needed; 1 inh every 4hrs may suffice. EIB: 2 inh 15−30min before exercise.
levalbuterol HCl Xopenex 0.31mg/
 
3mL,
0.63mg/
 
3mL,
1.25mg/
 
3mL
soln <6yrs: Not recommended.
6−11yrs: 0.31mg by nebulization 3 times daily; max 0.63mg 3 times daily.
>12yrs: Initially 0.63mg 3 times daily at 6−8hrs intervals; may increase to 1.25mg 3 times daily.
Xopenex Concen-
trate
1.25mg/
 
0.5mL
soln
levalbuterol tartrate Xopenex HFA 45mcg MDI <4yrs: Not established.
≥4yrs: 2 inh every 4−6hrs; 1 inh every 4hrs may suffice.
metapro-
terenol sulfate
5% soln <6yrs: Not recommended.
6−12yrs: Use nebulizer. 0.1−0.2mL 3−4 times daily, up to every 4hrs.
≥12yrs: 3−4 times daily (see full labeling).
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 4hrs.
LONG-ACTING BETA2‑AGONIST
salmeterol xinafoate Serevent Diskus 50mcg dry 
pwd
<4yrs: Not recommended.
≥4yrs: Asthma/Bronchospasm: 1 inh every 12hrs.
EIB: 1 inh at least 30min before exercise; max 2 doses/day.
MAST CELL STABILIZER
cromolyn sodium 20mg/
 
2mL
soln <2yrs: Not recommended.
≥2yrs: Use nebulizer. 20mg 4 times a day.
STEROID
beclometh-
asone dipropri-
onate
Qvar 40mcg,
80mcg
MDI <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.
budesonide Pulmicort Flexhaler 90mcg,
180mcg
dry 
pwd
<6yrs: Not recommended.
6−17yrs: Initially 180mcg twice daily; may start at 360mcg twice daily; max 360mcg twice daily.
≥18yrs: Initially 360mcg twice daily; 180mcg twice daily may suffice; max 720mcg twice daily.
Pulmicort Respules 0.25mg/
 
2mL,
0.5mg/
 
2mL,
1mg/
 
2mL
susp <6mos: Not recommended.
6−12mos: Not established.
12mos−8yrs: Previously on bronchodilators alone: 0.5mg once daily or 0.25mg twice daily. Previously on inhaled corticosteroids: 0.5mg once daily or 0.25mg twice daily; max 1mg/day. Previously on oral corticosteroids: 0.5mg twice daily or 1mg once daily.
ciclesonide Alvesco 80mcg,
160mcg
MDA <12yrs: Not recommended.
≥12yrs: 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 full labeling): 320mcg twice daily.
flunisolide Aerospan 80mcg/
 
inh
MDI <6yrs: Not recommended.
6−11yrs: 80mcg twice daily; max 160mcg twice daily.
Adults: 160mcg twice daily; max 320mcg twice daily.
fluticasone furoate Arnuity Ellipta 100mcg,
200mcg
dry 
pwd
Children: Not established.
Adults: Base initial dose on previous asthma therapy and disease severity. Not on inhaled corticosteroid: usually initiate at 100mcg once daily; may increase to 200mcg once daily if inadequate response after 2 weeks. Max 200mcg/day.
fluticasone propionate Flovent Diskus 50mcg,
100mcg,
250mcg
dry 
pwd
<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 44mcg,
110mcg,
220mcg
MDI <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.
momet-
asone furoate
Asmanex HFA 100mcg,
200mcg
MDI Children: Not established.
Adults: Previously on inhaled medium-dose corticosteroids: use 100mcg strength. Previously on inhaled high-dose or oral corticosteroids (wean gradually): use 200mcg strength. For both: 2 inh twice daily (AM & PM).
Asmanex Twisthaler 110mcg,
220mcg
dry 
pwd
<4yrs: Not established.
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.
STEROID + LONG-ACTING BETA2‑AGONIST
budesonide/
formoterol fumarate
dihydrate
Symbicort 80mcg/4.5mcg,
160mcg/4.5mcg
MDI ≥12yrs: 2 inh twice daily; max 160/4.5 twice daily.
fluticasone furoate/
vilanterol
Breo Ellipta 100mcg/25mcg,
200mcg/25mcg
dry 
pwd
Children: Not established.
Adults: Initially 1 inh of 100/25mcg or 200/25mcg once daily; max 1 inh of 200/25mcg once daily. Previously on low- to mid-dose corticosteroid: consider 100/25mcg; mid- to high-dose corticosteroid: consider 200/25mcg.
fluticasone propionate/
salmeterol
Advair Diskus 100mcg/50mcg,
250mcg/50mcg,
500mcg/50mcg
dry 
pwd
<4yrs: Not recommended.
4−11yrs: 1 inh of 100/50 twice daily
≥12yrs: 1 inh of 100/50, 250/50, or 500/50 twice daily; max 1 inh of 500/50 twice daily.
Advair HFA 45mcg/21mcg,
115mcg/21mcg,
230mcg/21mcg
MDI <12yrs: Not recommended.
≥12yrs: 2 inh of 45/21, 115/21, or 230/21 twice daily; max 2 inh 230/21 twice daily.
momet-
asone furoate/
formoterol fumarate
Dulera 100mcg/5mcg,
200mcg/5mcg
MDI <12yrs: Not established.
≥12yrs: Previously on medium dose of steroid: Use 100/5. Previously on high dose of steroid: Use 200/5. Both: 2 inh twice daily.
NOTES

Key: dry pwd = dry powder for inhalation; EIB = exercise induced bronchospasm; MDI = metered-dose inhaler; MDA = metered dose aerosol; soln = solution for inhalation; susp = suspension for inhalation

(Rev. 7/2016)

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