−This Clinical Resource gives subscribers

additional insight related to the Recommendations published in−

April 2017 ~ Resource #330402

Inhaled Corticosteroid Dose Comparison in Asthma

The chart below provides inhaled corticosteroid dose comparisons based on clinical trials in asthma without a spacer. Consider extent of control and
disease severity when switching. Doses are approximate; monitor response closely and adjust dose as appropriate. Some information may differ
from U.S. prescribing information.
Abbreviations: DPI=dry powder inhaler; HFA=hydrofluoroalkane.
a. Based on references 1, 6, and 12 unless otherwise denoted.

Medication/ Comparative Daily Dosesa

strengths 12 yrs and older 12 yrs and older 12 yrs and older 5 to 11 yrs 5 to 11 yrs 5 to 11 yrs
available Low Range Medium Range High Dose Low Range Medium Range High Dose
Beclomethasone 80 mcg to 280 mcg to >480 mcg 80 mcg to 200 mcg to 320 mcg >320 mcg
HFA 240 mcg 480 mcg 160 mcg
(QVAR) (Max FDA- (Max FDA-approved (Max FDA-approved
(Max FDA- approved dose for dose for ages dose for ages
40 mcg/ approved dose age >12 yrs is 5 to 11 yrs is 80 mcg 5 to 11 yrs is 80 mcg
inhalation, for age >12 yrs is 320 mcg twice twice daily.2) twice daily.2)
80 mcg/ 320 mcg twice daily.2)
inhalation daily.2)

Budesonide DPI 180 mcg to 630 mcg to >1200 mcg 180 mcg to 450 mcg to >800 mcg
(Pulmicort 540 mcg 1170 mcg 360 mcg 720 mcg
Flexhaler) (Max FDA- (FDA-approved for
(Max FDA- approved dose for (FDA-approved (FDA-approved for ages 6 to 17 yrs. Max
90 mcg/ approved dose ages 6 to 17 yrs is for children children 6 to 17 yrs dose 360 mcg twice
inhalation, for ages 360 mcg twice 6 to 17 yrs of of age.3) daily.3)
180 mcg/ 6 to 17 yrs is daily, and age.3)
inhalation 360 mcg twice 720 mcg twice
daily.3) daily for ages
18 yrs and older.3)

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 (Clinical Resource #330402: Page 2 of 6)

Medication/ Comparative Daily Dosesa

strengths 12 yrs and older 12 yrs and older 12 yrs and older 5 to 11 yrs 5 to 11 yrs 5 to 11 yrs
available Low Range Medium Range High Dose Low Range Medium Range High Dose
Budesonide FDA approved FDA approved FDA approved for 0.5 mg 1 mg 2 mg
nebulizer for children for children children
suspension 12 mos to 8 yrs 12 mos to 8 yrs 12 mos to 8 yrs of (FDA approved (FDA approved for (FDA-approved for
(Pulmicort of age.4 of age.4 age.4 for children children 12 mos to children 12 mos to
Respules) 12 mos to 8 yrs 8 yrs of age.4) 8 yrs of age. Max dose
of age.4) 1 mg.4)
0.25 mg/2 mL,
0.5 mg/2 mL,
1 mg/2 mL

Budesonide/ 320/18 mcg15 320/18 mcg to 640/18 mcg15 FDA approved FDA approved dose FDA approved dose in
formoterol HFA 640/18 mcg15 dose in children in children 6 to 12 yrs children 6 to 12 yrs of
(Symbicort) 6 to 12 yrs of age of age is age is 160 mcg/9 mcg
80/4.5 mcg or is 160 mcg/9 mcg 160 mcg/9 mcg twice twice daily.15
160/4.5 mcg per twice daily.15 daily.15
inhalation

Ciclesonide 80 mcg to >160 mcg to >320 mcg 80 mcg >80 to 160 mcg >160 mcg
HFA 160 mcg 320 mcg
(Alvesco) (Max dose (FDA-approved (FDA-approved for (FDA-approved for
320 mcg twice for age >12 yrs.5) age >12 yrs.5) age >12 yrs. Max dose
80 mcg/ daily.5) 320 mcg twice daily.5)
inhalation,
160 mcg/
inhalation

Flunisolide HFA 320 mcg 400 mcg to >640 mcg 160 mcg 320 mcg >640 mcg
(Aerospan) 640 mcg
80 mcg/ (Max FDA- (FDA-approved for (FDA-approved for
inhalation approved dose for children 6 to 11 yrs children 6 to 11 yrs of
age >12 yrs is of age.7) age. Max dose
320 mcg twice 160 mcg twice daily.7)
daily.7)
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 (Clinical Resource #330402: Page 3 of 6)

Medication/ Comparative Daily Dosesa

strengths
available 12 yrs and older 12 yrs and older 12 yrs and older 5 to 11 yrs 5 to 11 yrs 5 to 11 yrs
Low Range Medium Range High Dose Low Range Medium Range High Dose
Fluticasone 100 mcg N/A 200 mcg Not FDA- Not FDA-approved Not FDA-approved for
furoate DPI approved for for children <12 yrs children <12 yrs of
(Arnuity Ellipta) children <12 yrs of age.16 age.16
100 mcg/blister, of age.16
200 mcg/blister

Fluticasone 100/25 mcg N/A 200/25 mcg FDA-approved FDA-approved only FDA-approved only
furoate/ (FDA-approved only for adults for adults age 18 and for adults age 18 and
vilanterol DPI (FDA-approved only for adults age age 18 and older.17 older.17
(Breo Ellipta) only for adults 18 and older.17) older.17
100/25 mcg or age 18 and
200/25 mcg per older.17)
blister

Fluticasone 88 mcg to 264 mcg to >440 mcg 88 mcg to 220 mcg to >352 mcg
propionate HFA 264 mcg 440 mcg 176 mcg 352 mcg
(Flovent-HFA) (Max FDA- (Max FDA-approved
44 mcg/ approved dose for (FDA-approved (Max FDA-approved dose for children
inhalation, age >12 yrs is for children dose for children 4 to 11 yrs of age is
110 mcg/ 880 mcg twice 4 to 11 yrs of 4 to 11 yrs of age is 88 mcg twice daily.8)
inhalation, daily.8) age.8) 88 mcg twice daily.8)
220 mcg/
Inhalation

Fluticasone 100/50 to 300/50 mcg to >500/50 mcg Not FDA- Not FDA-approved Not FDA-approved for
propionate/ 250/50 mcg 500/50 mcg approved for for children <12 yrs children <12 yrs of
salmeterol HFA (Max FDA- children <12 yrs of age.11 age.11
(Advair HFA) approved dose for of age.11
50/25 mcg, age >12 yrs is
125/25 mcg, or 500/50 mcg twice
250/25 mcg per daily.11)
inhalation
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 (Clinical Resource #330402: Page 4 of 6)

Medication/ Comparative Daily Dosesa

strengths
12 yrs and older 12 yrs and older 12 yrs and older 5 to 11 yrs 5 to 11 yrs 5 to 11 yrs
available
Low Range Medium Range High Dose Low Range Medium Range High Dose
Fluticasone 100/50 mcg to 350/100 mcg to >500/50 mcg 100/50 mcg to 250/50 mcg to >500/50 mcg
propionate/ 350/100 mcg 500/100 mcg 200/100 mcg 350/100 mcg
salmeterol DPI (Max FDA- (FDA-approved for
(FDA-approved
(Advair Diskus) approved dose for (FDA-approved for children 4 to 11 yrs of
for children
100/50 mcg, age >12 yrs is children 4 to 11 yrs age at a dose of
4 to 11 yrs of age
250/50 mcg, or 500/50 mcg twice of age at a dose of 100/50 mcg twice
at a dose of
500/50 mcg per daily.13) 100/50 mcg twice daily.13)
100/50 mcg twice
blister daily.13)
daily.13)
Fluticasone 110/28 mcg18 226/28 mcg18 464/28 mcg18 Not FDA- Not FDA-approved Not FDA-approved for
propionate/ approved for for children <12 yrs children <12 yrs of
salmeterol DPI children <12 yrs of age.18 age.18
(Airduo of age.18
Respiclick)
55/14 mcg,
113/14 mcg, or
232/14 mcg per
inhalation
Fluticasone 110 mcg19 226 mcg19 464 mcg19 Not FDA- Not FDA-approved Not FDA-approved for
propionate DPI approved for for children <12 yrs children <12 yrs of
(Armonair children <12 yrs of age.19 age.19
Respiclick) of age.19
55 mcg,
113 mcg, or
232 mcg per
inhalation
Fluticasone 100 mcg to 350 mcg to >500 mcg 100 mcg to 250 mcg to 400 mcg >400 mcg
propionate DPI 300 mcg 500 mcg 200 mcg
(Flovent Diskus) (Max FDA- (Max FDA-approved (Max FDA-approved
50 mcg/blister, approved dose for (FDA-approved dose for children dose for children
100 mcg/blister, age >12 yrs is for children 4 to 11 yrs of age is 4 to 11 yrs of age is
250 mcg/blister 1000 mcg twice 4 to 11 yrs of 100 mcg twice 100 mcg twice daily.9)
daily.9) age.9) daily.9)

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 (Clinical Resource #330402: Page 5 of 6)

Medication/ Comparative Daily Dosesa

strengths 12 yrs and older 12 yrs and older 12 yrs and older 5 to 11 yrs 5 to 11 yrs 5 to 11 yrs
available Low Range Medium Range High Dose Low Range Medium Range High Dose
Mometasone 110 mcg to 330 mcg to >440 mcg 110 mcg 220 mcg to <440 mcg >440 mcg
DPI 220 mcg 440 mcg
(Asmanex (Max FDA- (FDA-approved (Max FDA-approved (Max FDA-approved
Twisthaler) approved dose for for children dose for children dose for children
age >12 yrs is 4 to 11 yrs of 4 to 11 yrs of age is 4 to 11 yrs of age is
110 mcg/ 440 mcg twice age.10) 110 mcg once 110 mcg once daily.10)
inhalation, daily.10) daily.10)
220 mcg/
inhalation
Mometasone/ N/A 400/20 mcg14 800/20 mcg14 Not FDA- Not FDA-approved Not FDA-approved for
Formoterol HFA approved for for children <12 yrs children <12 yrs of
(Dulera) children <12 yrs of age.14 age.14
of age.14
100/5 mcg or
200/5 mcg per
inhalation

Users of this resource are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical
judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and internet links in this article were current as of the date of publication

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 (Clinical Resource #330402: Page 6 of 6)

Project Leader in preparation of this clinical 10. Product information for Asmanex Twisthaler. Merck
resource (330402): Melanie Cupp, Pharm.D., & Co., Inc. Whitehouse Station, NJ 08889.
September 2014.
BCPS 11. Product information for Advair HFA.
GlaxoSmithKline. Research Triangle Park, NC
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an update. Ann Pharmacother 2009;43:519-27. National Institutes of Health. National Heart, Lung,
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Pharmaceuticals LLC. Horsham, PA 19044. July Prevention Program, expert panel report 3.
2014. Summary report 2007. Guidelines for the diagnosis
3. Product information for Pulmicort Flexhaler. and management of asthma.
AstraZeneca LP. Wilmington, DE 19850. October http://www.nhlbi.nih.gov/guidelines/asthma/asthsum
2016. m.pdf. (Accessed February 27, 2017).
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AstraZeneca LP. Wilmington, DE 19850. November GlaxoSmithKline. Research Triangle Park, NC
2016. 27709. April 2016.
5. Product information for Alvesco. Sunovion 14. Product information for Dulera. Merck & Co., Inc.
Pharmaceuticals Inc. Marlborough, MA 01752. Whitehouse Station, NJ 08889. July 2016.
January 2013. 15. Product information for Symbicort. AstraZeneca LP.
6. Global Initiative for Asthma. Global strategy for Wilmington, DE 19850. January 2017.
asthma management and prevention. Revised 2017. 16. Product information for Arnuity Ellipta.
http://ginasthma.org/2017-gina-report-global- GlaxoSmithKline. Research Triangle Park, NC
strategy-for-asthma-management-and-prevention/ 27709. November 2014.
(Accessed March 6, 2017). 17. Product information for Breo Ellipta.
7. Product information for Aerospan. Meda GlaxoSmithKline. Research Triangle Park, NC
Pharmaceuticals. Somerset, NJ 08873. June 2015. 27709. July 2016.
8. Product information for Flovent-HFA. 18. Product information for Airduo Respiclick. Teva
GlaxoSmithKline. Research Triangle Park, NC Respiratory, LLC. Frazer, PA 19355. January 2017.
27709. September 2016. 19. Product information for Armonair Respiclick. Teva
9. Product information for Flovent Diskus. Respiratory, LLC. Frazer, PA 19355. January 2017.
GlaxoSmithKline. Research Triangle Park, NC
27709. September 2016.

Cite this document as follows: Clinical Resource, Inhaled Corticosteroid Dose Comparison in Asthma.
Pharmacist’s Letter/Prescriber’s Letter. April 2017.

Evidence and Recommendations You Can Trust…

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Copyright 2017 by Therapeutic Research Center

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