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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -71 مورد

Usual doses of combined inhaled glucocorticoids and bronchodilators for maintenance therapy in adolescents ≥12 years and adults

Usual doses of combined inhaled glucocorticoids and bronchodilators for maintenance therapy in adolescents ≥12 years and adults
Medication Low-dose Medium-dose High-dose
ICS-LABA combinations
Beclomethasone [beclometasone]-formoterol DPI or HFA (Not available in United States or Canada, but available elsewhere [sample brand names: Formodual, Fostair, Foster])*
100 mcg/6 mcg 1 inhalation twice daily 2 inhalations twice daily  
200 mcg/6 mcg     2 inhalations twice daily
Budesonide-formoterol HFA (Brand names: Symbicort, Breyna)
80 mcg/4.5 mcg 2 inhalations twice daily    
160 mcg/4.5 mcg   2 inhalations twice daily  
Fluticasone furoate-vilanterol DPI (Brand name: Breo Ellipta)*
NOTE: Inhaled fluticasone furoate has a greater anti-inflammatory potency per microgram than fluticasone propionate inhalers. Thus, fluticasone furoate is administered at a lower daily dose and used only once daily.
50 mcg/25 mcg 1 inhalation once daily    
100 mcg/25 mcg   1 inhalation once daily  
200 mcg/25 mcg     1 inhalation once daily
Fluticasone propionate-formoterol MDI (Not available in United States or Canada, but available elsewhere [sample brand name: Flutiform])
50 mcg/5 mcg 2 inhalations twice daily    
125 mcg/5 mcg   2 inhalations twice daily  
250 mcg/10 mcg     2 inhalations twice daily
Fluticasone propionate-salmeterol DPI (Brand names: Advair Diskus, Wixela Inhub)*
100 mcg/50 mcg 1 inhalation twice daily    
250 mcg/50 mcg   1 inhalation twice daily  
500 mcg/50 mcg     1 inhalation twice daily
Fluticasone propionate-salmeterol HFA (Brand name: Advair HFA)
45 mcg/21 mcg 2 inhalations twice daily    
115 mcg/21 mcg   2 inhalations twice daily  
230 mcg/21 mcg     2 inhalations twice daily
Fluticasone propionate-salmeterol DPI (Brand names: AirDuo RespiClick, AirDuo Digihaler)*Δ
55 mcg/14 mcg 1 inhalation twice daily    
113 mcg/14 mcg 1 inhalation twice daily 1 inhalation twice daily  
232 mcg/14 mcg     1 inhalation twice daily
Mometasone-formoterol HFA (Brand name: Dulera)
100 mcg/5 mcg 1 inhalation twice daily 2 inhalations twice daily  
200 mcg/5 mcg     2 inhalations twice daily
Mometasone-indacaterol DPI (Brand name: Atectura Breezhaler; available in Canada)*
80 mcg/150 mcg 1 inhalation (capsule) once daily    
160 mcg/150 mcg   1 inhalation (capsule) once daily  
320 mcg/150 mcg     1 inhalation (capsule) once daily
ICS-LAMA-LABA combinations◊
Fluticasone furoate-umeclidinium-vilanterol DPI (Brand name: Trelegy Ellipta)*
100 mcg/62.5 mcg/25 mcg   1 inhalation once daily  
200 mcg/62.5 mcg/25 mcg     1 inhalation once daily
Mometasone-glycopyrrolate (glycopyrronium)-indacaterol DPI (Brand name: Enerzair Breezhaler; available in Canada)*§
160 mcg/50 mcg/150 mcg     1 inhalation (capsule) once daily
  • Do not exceed the maximum number of inhalations/puffs per day listed in the table due to the risk of toxicity from an excess dose of salmeterol, vilanterol, or indacaterol. When using ICS-formoterol as maintenance and reliever therapy (MART), the maximum daily dose of maintenance and rescue is 12 inhalations.
  • Brand names and dose per puff or inhalation of commercially available fixed-dose combinations are according to United States prescribing information, unless otherwise noted. Some doses are outside the approved product information recommendations. Consult local product information before use.
  • The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy. The clinician must monitor the patient's response on several clinical parameters and adjust the regimen accordingly. The stepwise approach to therapy emphasizes that once control of asthma is achieved, the dose of ICS should be carefully titrated to the minimum dose required to maintain control, thus reducing the potential for adverse effects.
  • Suggested regimens to achieve low-, medium-, and high-dose ICS are based on daily ICS doses recommended by Global Initiative for Asthma (GINA), National Asthma Education and Prevention Program (NAEPP), and/or product labeling[1-5]. This is not a table of equivalence. Low-dose ICS provides most of the clinical benefit of ICS for most patients. However, some patients with daily activity limitations may require medium-dose ICS. High-dose ICS is required by very few patients and potential benefit must be balanced against increased risk of side effects with long-term use.[1]
  • Please refer to UpToDate content on initiation and maintenance of asthma therapy in adolescents ≥12 years and adults for additional information.

DPI: dry powder inhaler; HFA: metered-dose inhaler with hydrofluoroalkane propellant; ICS: inhaled glucocorticoid (inhaled corticosteroid); LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; SMI: soft mist inhaler.

* DPI contains lactose which may have small amounts of milk protein.

¶ Fluticasone furoate-vilanterol 50 mcg/25 mcg DPI is approved for use in patients 5 to 11 years old; use in adolescents and adults is off-label.

Δ In AirDuo inhalers, the daily dose of salmeterol is approximately one-fourth of the dose in Advair, and the daily dose of fluticasone is approximately one-half that of the comparable low-, medium-, and high-dose strengths of Advair.

◊ Alternatively, tiotropium SMI (Brand name: Spiriva Respimat) can be used with an ICS or ICS-LABA inhaler. The dose in asthma is two inhalations (1.25 mcg/inhalation) once daily.

§ Not approved for use in patients <18 years old.
References:
  1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (2023 update). https://ginasthma.org/2023-gina-main-report/ (Accessed on June 13, 2023).
  2. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol 2007; 120:S94.
  3. US National Library of Medicine. US Food and Drug Administration (FDA) approved product information. https://www.dailymed.nlm.nih.gov/dailymed/index.cfm (Accessed on June 4, 2024).
  4. Health Canada. Health Canada approved product monograph. https://health-products.canada.ca/dpd-bdpp/ (Accessed on June 4, 2024).
  5. European Medicines Agency. European Medicines Agency (EMA) summary of product characteristics. https://www.ema.europa.eu/en/medicines (Accessed on June 4, 2024).
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