Usual doses of ICS-formoterol preparations for maintenance and reliever therapy

DPI: dry powder inhaler; ICS: inhaled glucocorticoid (inhaled corticosteroid); MART: maintenance and reliever therapy; MDI: metered-dose inhaler.

* For patients with well-controlled asthma stepping down from low-dose MART, our authors suggest a trial of even lower dose maintenance therapy, achieved by halving the maintenance dose (ie, changing to once daily administration or reducing the number of actuations per dose). Patients with good control on this very low-dose maintenance regimen can be transitioned to anti-inflammatory reliever therapy alone. Refer to related table for more detail on anti-inflammatory reliever therapy dosing.

¶ Maximum total daily dose of maintenance and rescue is 12 inhalations. Do not exceed the maximum number of inhalations per day due to the risk of toxicity from an excess dose of formoterol. In some countries, product labeling includes a maximum total daily dose of eight inhalations. Use of reliever therapy daily or more frequently over a four-week period indicates poor asthma control and should prompt provider evaluation.

Δ For at-home acute exacerbations, one to two inhalations should be taken as needed for initial symptoms. We advise waiting a few minutes between doses, giving the second dose if symptoms persist. One to two inhalations may be repeated every 20 minutes for up to six inhalations in one hour. Over the course of the first hour, the patient can determine (based on action plan or clinician guidance) whether to continue self-care at home or seek additional medical attention. When self-administering an MDI for acute asthma exacerbation, use of a valved holding chamber (for compatible MDIs) and careful attention to technique are recommended.