Management of Asthma - Inhaled Corticosteroid Doses (BTS/SIGN Guideline)

Categorisation of inhaled corticosteroid doses in asthma.

KEY: od= once daily bd= twice daily

CHILDREN ADULTS
Very low dose Low dose Medium dose* Low dose Medium dose High dose*
PRESSURISED METERED DOSE INHALERS (with spacer in children)
Beclometasone dipropionate
Non-proprietary

50 mcg x2 puffs bd

100 mcg x2 puffs bd 200 mcg x2 puffs bd  100 mcg x2 puffs bd 200 mcg x2 puffs bd 200 mcg x4 puffs bd
Clenil Modulite 50 mcg x2 puffs bd 100 mcg x2 puffs bd 200 mcg x2 puffs bd 100 mcg x2 puffs bd 200 mcg x2 puffs bd 250 mcg x2 puffs bd, or 250 mcg x4 puffs bd
Qvar (extrafine)/ Autohaler/ Easi-breathe 50 mcg x2 puffs bd   100 mcg x2 puffs bd 50 mcg x2 puffs bd 100 mcg x2 puffs bd 100 mcg x4 puffs bd 
Ciclesonide
Alvesco 80 mcg x2 puffs od 160 mcg x2 puffs od 80 mcg x2 puffs od 160 mcg x2 puffs od
Fluticasone propionate
Flixotide Evohaler 50 mcg x1 puff bd 50 mcg x2 puffs bd 125 mcg x2 puffs bd 50 mcg x2 puffs bd 125 mcg x2 puffs bd 250 mcg x2 puffs bd
DRY POWDER INHALERS
Beclometasone
Non-proprietary/ Easyhaler 200 mcg x1 puff bd 200 mcg x2 puffs bd

Budesonide
Non-proprietary/ Easyhaler 100 mcg x2 puffs bd 200 mcg x2 puffs bd 100 mcg x2 puffs bd 200 mcg x2 puffs bd 400 mcg x2 puffs bd
Budelin Novolizer 200 mcg x2 puffs bd 200 mcg x4 puffs bd
Pulmicort Turbohaler 100 mcg x1 puff bd 100 mcg x2 puffs bd, or
200 mcg x1 puff bd
200 mcg x2 puffs bd, or
400 mcg x1 puff bd
100 mcg x2 puffs bd, or
200 mcg x1 puff bd
200 mcg x2 puffs bd, or
400 mcg x1 puff bd
400 mcg x2 puffs bd
Fluticasone propionate
Flixotide Accuhaler 50 mcg x1 puff bd 100 mcg x1 puff bd 250 mcg x1 puff bd 100 mcg x1 puff bd 250 mcg x1 puff bd 500 mcg x1 puff bd
Mometasone
Asmanex Twisthaler 200 mcg x1 puff bd 200 mcg x1 puff bd 400 mcg x1 puff bd
COMBINATION INHALERS
Beclometasone dipropionate (extrafine) + formoterol
Fostair (pMDI) 100/6 x1 puff bd 100/6 x2 puffs bd 200/6 x2 puffs bd 
Fostair (NEXThaler) 100/6 x1 puff bd 100/6 x2 puffs bd 200/6 x2 puffs bd
Budesonide + formoterol
DuoResp Spiromax 200/6 x1 puff bd 200/6 x2 puffs bd, or
400/12 x1 puff bd
400/12 x2 puffs bd
Symbicort Turbohaler 100/6 x1 puff bd†† 100/6 x2 puffs bd††, or
200/6 x1 puff bd
100/6 x2 puffs bd, or
200/6 x1 puff bd
200/6 x2 puffs bd, or
400/12 x1 puff bd
400/12 x2 puffs bd
Fluticasone propionate + formoterol
Flutiform 50/5 x2 puffs bd 125/5 x2 puffs bd 250/10 x2 puffs bd
Fluticasone propionate + salmeterol
Seretide Accuhaler 100/50 x1 puff bd 100/50 x1 puff bd 250/50 x1 puff bd 500/50 x1 puff bd
Seretide Evohaler 50/25 x2 puffs bd 50/25 x2 puffs bd 125/25 x2 puffs bd 250/25 x2 puffs bd
Fluticasone furoate + vilanterol
Relvar 92/22 x1 puff od 184/22 x1 puff od

*Medium doses in children and high doses in adults should only be used after referring the patient to secondary care.
Not licensed for children under 12 years.
Not licensed for children under 6 years.

Note: Different products and doses are licensed for different age groups; check before prescribing.

Source British Thoracic Society/Scottish Intercollegiate Guidelines Network (and others). British Guideline on the Management of Asthma (September 2016). 

 


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