Asthma Treatments: Inhalations




ASTHMA TREATMENTS: INHALATIONS
Generic Brand Strength Form Dosage
ANTICHOLINERGIC
ipratropium bromide 0.02% soln Children: Not recommended.

Adults: 500mcg orally by nebulization 3−4 times daily;
separate doses by 6−8hrs.
Atrovent HFA 17mcg MDI Children: Not established.

Adults: 2 inh 4 times daily; max 12 inh/day.
tiotropium bromide monohydrate Spiriva Respimat 1.25mcg, 2.5mcg soln Children: Not established.

Adults: 2 inh of 1.25mcg/actuation (2.5mcg) once daily.
BETA2-AGONIST
albuterol sulfate 0.5% soln Children: Use other forms.

Adults: Use nebulizer. 2.5mg 3−4 times daily.
0.083% soln <4yrs: Not recommended.

≥4yrs: Bronchospasm: 2 inh every 4−6hrs as needed; 1 inh every 4hrs may suffice.

EIB: 2 inh 15min before exercise.
90mcg MDI
ProAir HFA 90mcg MDA <4yrs: Not established.

≥4yrs: Bronchospasm: 2 inh every 4−6hrs; 1 inh every 4hrs may suffice.

EIB: 2 inh 15−30min before exercise.
ProAir RespiClick 90mcg dry 
pwd
<4yrs: Not established.
≥4yrs: Bronchospasm: 2 inh every 4−6hrs; in some patients: 1 inh every 4hrs may suffice.

EIB: 2 inh 15−30min before exercise.
Proventil HFA 90mcg MDA <4yrs: Not established.
Ventolin HFA 90mcg MDA ≥4yrs: Bronchospasm: 2 inh every 4−6hrs as needed; 1 inh every 4hrs may suffice. EIB: 2 inh 15−30min before exercise.
levalbuterol HCl Xopenex 0.31mg/
 
3mL,

0.63mg/
 
3mL,

1.25mg/
 
3mL
soln <6yrs: Not established.

6−11yrs: 0.31mg by nebulization 3 times daily; max 0.63mg 3 times daily.

≥12yrs: Initially 0.63mg 3 times daily at 6−8hrs
intervals; may increase to 1.25mg 3 times daily.
Xopenex Concen
trate
1.25mg/
 
0.5mL
soln
levalbuterol tartrate Xopenex HFA 45mcg MDI <4yrs: Not established.

≥4yrs: 2 inh every 4−6hrs; 1 inh every 4hrs may suffice.
LONG-ACTING BETA2‑AGONIST
salmeterol xinafoate Serevent Diskus 50mcg dry 
pwd
<4yrs: Not established.
≥4yrs: Asthma: 1 inh twice daily (approx. 12hrs apart) with concomitant ICS. EIB: 1 inh ≥30mins before exercise; do not use additional doses for 12hrs after administration or if already using twice daily dosing. Max 1 inh twice daily.
MAST CELL STABILIZER
cromolyn sodium 20mg/
 
2mL
soln <2yrs: Not recommended.

≥2yrs: Use nebulizer. 20mg 4 times a day.
STEROID
beclometh
asone dipropri
onate
Qvar Redihaler 40mcg, 80mcg MDI <4yrs: Not established.

4−11yrs: Initially 40mcg twice daily (approx. 12hrs apart); max 80mcg twice daily.

Adults: Previously not on inhaled corticosteroids: Initially 40–80mcg twice daily (approx. 12hrs apart). Previously on inhaled corticosteroids: Initially 40–320mcg twice daily. Both: Max 320mcg twice daily.
budesonide Pulmicort Flexhaler 90mcg,
180mcg
dry 
pwd
<6yrs: Not recommended.

6−17yrs: Initially 180mcg twice daily; may start at 360mcg twice
daily; max 360mcg twice daily.

≥18yrs: Initially 360mcg twice daily; 180mcg twice daily may
suffice; max 720mcg twice daily.
Pulmicort Respules 0.25mg/
 
2mL,

0.5mg/
 
2mL,

1mg/
 
2mL
susp <6mos: Not recommended.

6−12mos: Not established.

12mos−8yrs: Previously on bronchodilators alone: 0.5mg
once daily or 0.25mg twice daily. Previously on inhaled corticosteroids: 0.5mg once
daily or 0.25mg twice daily; max 1mg/day. Previously on oral corticosteroids:
0.5mg twice daily or 1mg once daily.
ciclesonide Alvesco 80mcg,

160mcg
MDA <12yrs: Not recommended.

≥12yrs: Previously on bronchodilators alone: Initially
80mcg twice daily, max 160mcg twice daily. Previously on inhaled corticosteroids:
Initially 80mcg twice daily; max 320mcg twice daily. Previously on oral corticosteroids
(see full labeling):
320mcg twice daily.
flunisolide Aerospan 80mcg/
 
inh
MDI <6yrs: Not recommended.

6−11yrs: Initally 80mcg twice daily (approx. 12hrs apart); may increase to max 160mcg twice daily.

≥12yrs: Initially 160mcg twice daily (approx. 12hrs apart); may increase to max 320mcg twice daily.
fluticasone furoate Arnuity Ellipta 50mcg, 100mcg,

200mcg
dry 
pwd
<5yrs: Not established.
5–11yrs:
50mcg once daily.

≥12yrs: Base initial dose on previous asthma therapy and disease severity.
Not on inhaled corticosteroid: usually initiate at 100mcg once daily; may increase to
200mcg once daily if inadequate response after 2 weeks. Max 200mcg/day.
fluticasone propionate ArmonAir RespiClick 55mcg, 113mcg, 232mcg dry 
pwd
<12yrs: Not established.

≥12yrs:
Previously on inhaled steroids: Initially 1 inh of 55mcg, 113mcg, or 232mcg twice daily (approx. 12hrs apart) based on asthma severity and previous steroid dose. Not on inhaled steroid: Initially 55mcg twice daily. Both: Max 232mcg twice daily.
Flovent Diskus 50mcg,

100mcg,

250mcg
dry 
pwd
<4yrs: Not recommended.

4−11yrs: Previously on bronchodilators alone or on inhaled
corticosteroids:
Initially 50mcg twice daily; max 100mcg twice daily.

≥11yrs: Previously on bronchodilators alone: Initially
100mcg twice daily; max 500mcg twice daily. Previously on inhaled corticosteroids:
Initially 100−250mcg twice daily; max 500mcg twice daily. Previously on oral
corticosteroids
(wean gradually): Initially 500−1000mcg twice daily; max 1000mcg
twice daily.
Flovent HFA 44mcg,

110mcg,

220mcg
MDI <4yrs: Not established.

4−11yrs: max 88mcg twice daily.

≥12yrs: Previously on bronchodilators alone: Initially
88mcg twice daily; max 440mcg twice daily. Previously on inhaled steroids:
Initially 88−220mcg twice daily; max 440mcg twice daily. Previously on oral
steroids:
Initially 440mcg twice daily; max 880mcg twice daily.
momet
asone furoate
Asmanex HFA 100mcg,

200mcg
MDI Children: Not established.

Adults: Previously on inhaled medium-dose corticosteroids: use 100mcg
strength. Previously on inhaled high-dose or oral corticosteroids (wean gradually): use 200mcg
strength. For both: 2 inh twice daily (AM & PM).
Asmanex Twisthaler 110mcg,

220mcg
dry 
pwd
<4yrs: Not established.

4−11yrs: 110mcg once in PM; max 110mcg/day.

≥12yrs: Previously on bronchodilators alone or inhaled
steroids:
Initially 220mcg once in PM; max 440mcg/day (as 2 inh once daily or
1 inh twice daily). Previously on oral steroids: Initially 440mcg twice daily;
max 880mcg/day.
STEROID + LONG-ACTING BETA2‑AGONIST
budesonide/

formoterol fumarate

dihydrate
Symbicort 80mcg/4.5mcg,

160mcg/4.5mcg
MDI <6yrs: Not established.
6–<12yrs: 2 inh of 80/4.5 twice daily (AM & PM).
≥12yrs: Base initial dose on asthma severity. 2 inh of 80/4.5 or 160/4.5 twice daily (AM & PM). If insufficient response after 1–2wks of 80/4.5 strength, may switch to 160/4.5 strength. Max 2 inh of 160/4.5 twice daily.
fluticasone furoate/
vilanterol
Breo Ellipta 100mcg/25mcg,

200mcg/25mcg
dry 
pwd
Children: ≤17yrs: Not established.

Adults: Initially 1 inh of 100/25mcg or 200/25mcg once daily, based on disease severity and previous asthma therapy. Max 1 inh of 200/25mcg once daily.
fluticasone propionate/
salmeterol
Advair Diskus 100mcg/50mcg,

250mcg/50mcg,
500mcg/50mcg
dry 
pwd
<4yrs: Not established.

4−11yrs: 1 inh of 100/50 twice daily

≥12yrs: Initially 1 inh of 100/50, 250/50 or 500/50 twice daily, based on disease severity and previous asthma therapy; if insufficient response after 2wks, use next higher strength. Max 1 inh of 500/50 twice daily.
Advair HFA 45mcg/21mcg,

115mcg/21mcg,

230mcg/21mcg
MDI <12yrs: Not established.

≥12yrs:Initially 2 inh of 45/21, 115/21 or 230/21 twice daily, based on disease severity and previous asthma therapy; if insufficient response after 2wks, use next higher strength. Max 2 inh of 230/21 twice daily.
AirDuo RespiClick 55mcg/14mcg, 113mcg/14mcg, 232mcg/14mcg dry pwd <12yrs: Not established.

≥12yrs: Not previously on ICS: initially 1 inh of 55/14mcg twice daily. Switching from an ICS or combination product: 1 inh of 55/14mcg, 113/14mcg or 232/14mcg twice daily, based on disease severity and previous asthma therapy. If insufficient response after 2wks, use next higher strength. Max 1 inh of 232/14mcg twice daily.
momet
asone furoate/

formoterol fumarate dihydrate
Dulera 100mcg/5mcg,

200mcg/5mcg
MDI <12yrs: Not established.

≥12yrs: Initially 2 inh of 100mcg/5mcg or 200mcg/5mcg twice daily (AM & PM), based on disease severity and previous asthma therapy. Max 2 inh of 200mcg/5mcg twice daily (max 800mcg/20mcg per day).
NOTES

Key: dry pwd = dry powder for inhalation;
EIB = exercise induced bronchospasm;
MDI = metered-dose inhaler;
MDA = metered dose aerosol;
soln = solution for inhalation;
susp = suspension for inhalation

(Rev. 4/2019)

This article originally appeared on MPR