Selecting a Treatment Regimen Table 3. Inhaled Corticosteroids – Comparable Daily Dosesa
Generic (Brand)
Budesonideb (Pulmicort Flexhaler®
)
Budesonideb (Pulmicort Turbuhaler®
Ciclesonide (Alvesco®
)
Flunisolide (Aerobid®
)
Fluticasone (Flovent®
Fluticasone (Flovent® Diskus®
)
Mometasone (Asmanex® Twisthaler®
) HFA) ) Dosage Form
DPI: 90 mcg/dose 180 mcg/dose
Daily Dose (inh bid unless otherwise indicated) Low
Medium
1-4 1-2
4-8 2-4
High
8-16 4-8
MDI: 200 mcg/dose Low dose 200 mcg bid; high dose 800 mcg bid Max dose: 800 mcg bid
DPI: 80 mcg/dose 160 mcg/dose
MDI: 250 mcg/ dose
MDI: 44 mcg/dose 110 mcg/dose 220 mcg/dose
Powder: 50, 100, 250 mcg
DPI: 110 mcg/dose 220 mcg/dose
Previous Therapy Bronchodilator alone
ICS
Oral corticosteroids
Triamcinolone (Azmacort®
) Combinations
Budesonide/ formoterolb (Symbicort®
)
Fluticasone/ salmeterolb (Advair Diskus®
)c
Fluticasone/ salmeterol (Advair HFA®
)c MDI: DPI: DPI:
80/4.5 mcg/dose 160/4.5 mcg/dose
100/50 mcg/dose 250/50 mcg/dose 500/50 mcg/dose
45/21 mcg/dose 115/21 mcg/dose 230/21 mcg/dose
1-2 inh bid (dose depends on asthma severity and current inhaled corticosteroid therapy) to maximum 2 inh bid (160/4.5 mcg/dose)
1 inh q12h Max dose: 500/50 mcg bid
1 inh bid 12 h apart Max dose: 230/21 mcg 2 inh bid
a See product labeling for complete prescribing information. b Budesonide alone or in combination with formoterol may be an alternative to oral glucocorticosteroids in the treatment of exacerbations and is associated with significantly reduced complications, although it is more expensive. c Do not use with spacer device.
MDI: 75 mcg/dose 4-10 2-4
2-4 1-2 1
100 mcg bid
1 inh bid to maximum of 320 mcg bid —
4-20 2-8 1-4
250-500 mcg bid
Daily Starting Dose
1 daily PM 1 daily PM
2 bid 10-16 4-8
20-40 16 8
1000 mcg bid
Daily Dose 2 2
Highest 4 16
