INHALED CORTICOSTEROIDS









Beclomethasone (Qvar®)

Dosage forms

Qvar® Redihaler 40
  • Delivers 40 mcg of beclomethasone per actuation
  • Comes in 10.6 g size with 120 actuations
  • Inhaler is breath-actuated
Qvar® Redihaler 80
  • Delivers 80 mcg of beclomethasone per actuation
  • Comes in 10.6 g size with 120 actuations
  • Inhaler is breath-actuated

Dosing

Asthma (4 - 11 years)
  • Starting: 40 mcg twice a day
  • Max: 80 mcg twice a day
  • For patients who do not respond to 40 mcg after 2 weeks, the dose may be increased to 80 mcg
  • Do not use spacer or volume holding chamber with Redihaler
Asthma (12 years and older)
  • Starting: 40 - 80 mcg twice a day
  • Max: 320 mcg twice a day
  • Patients who are already using an inhaled corticosteroid may require higher starting doses
  • Increase dose at two-week intervals if necessary
  • Do not use spacer or volume holding chamber with Redihaler

Generic / Price

- NO/$$$-$$$$

Other

  • Do not use spacer or volume holding chamber with Redihaler
  • Redihaler is breath-actuated meaning the inhaler releases medication when the patient takes a deep breath, and the patient does not need to push anything
  • Rinsing mouth after use may help prevent thrush

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients 4 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Qvar 320 mcg Placebo
Upper respiratory infection 4% 2%
Thrush 3% <1%
Nasopharyngitis 1% 1%
Mouth pain <1% <1%
Viral upper respiratory infection <1% 1%
Sinusitis <1% <1%
Other
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - beclomethasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to beclomethasone

Precautions / Contraindications

  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively

Budesonide (Pulmicort®)

Dosage forms

Pulmicort Flexhaler™
  • Pulmicort Flexhaler® 90 - contains 90 mcg of budesonide inhalation powder (60 actuations)
  • Pulmicort Flexhaler® 180 - contains 180 mcg of budesonide inhalation powder (120 actuations)
Pulmicort Respules® - nebulizer
  • 0.25 mg/2ml
  • 0.5 mg/2ml
  • 1 mg/2ml
  • 30 respules in a carton

Dosing - Flexhaler

Asthma (6 - 17 years)
  • Starting: 180 mcg twice a day
  • Max: 360 mcg twice a day
  • Rinsing mouth after use may help prevent thrush
Asthma (≥ 18 years)
  • Starting: 360 mcg twice a day
  • Max: 720 mcg twice a day
  • Rinsing mouth after use may help prevent thrush

Dosing - Respules

Asthma (1 - 8 years old)
  • Starting: 0.5 mg once daily or 0.25 mg twice a day
  • Max: 1 mg once daily or 0.5 mg twice a day
  • Rinsing mouth after use may help prevent thrush

Efficacy


Generic / Price

  • Inhaler - NO/$$$$
  • Respules (30 ampules) - YES/$$

Other

Pulmicort Respules®
  • Protect from sunlight
  • When an envelope has been opened, the shelf life of the unused ampules is 2 weeks when protected

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Flexhaler™ - 6 years of age and older
  • Respules® - 12 months - 8 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Budesonide Placebo
Nasopharyngitis 9.3% 8.3%
Nasal congestion 2.7% 0.4%
Pharyngitis 2.7% 1.7%
Allergic rhinitis 2.2% 1.3%
Viral upper respiratory infection 2.2% 1.3%
Nausea 1.8% 0.9%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - budesonide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to budesonide

Precautions / Contraindications

  • Severe milk allergy - (Flexhaler® only) - DO NOT USE - contains small amount of lactose
  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively

Ciclesonide (Alvesco®)

Dosage forms

Inhaler
  • Alvesco® 80 - delivers 80 mcg of ciclesonide per actuation
  • Alvesco® 160 - delivers 160 mcg of ciclesonide per actuation
  • Inhalers come with 60 actuations

Dosing

Asthma (12 years and older)
  • Starting: 80 mcg twice a day
  • Max: 320 mcg twice a day
  • Patients taking oral corticosteroids may require higher starting doses

Generic / Price

- NO/$$$$

Other

  • Rinsing mouth after use may help prevent thrush
  • Prime inhaler before first dose by releasing 3 puffs into the air
  • Prime inhaler if not used for more than 10 days

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients 12 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Ciclesonide Placebo
Headache 11% 7.3%
Nasopharyngitis 8.7% 7.5%
Upper respiratory infection 8.7% 6.5%
Sinusitis 5.5% 3%
Nasal congestion 5.5% 1.6%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - ciclesonide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to ciclesonide

Precautions / Contraindications

  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - no dose adjustment necessary
  • Kidney disease - has not been studied extensively

Flunisolide (Aerospan™)

Dosage forms

HFA inhaler
  • delivers 80 mcg of flunisolide per actuation
  • Inhaler comes with 120 actuations
  • Inhaler comes with built-in spacer

Dosing

Asthma (6 - 11 years)
  • Starting: 80 mcg twice a day
  • Max: 160 mcg twice a day
Asthma (≥ 12 years)
  • Starting: 160 mcg twice a day
  • Max: 320 mcg twice a day

Generic / Price

- NO/$$$$

Other

  • Aerospan™ comes with a built-in spacer
  • Rinsing mouth after use may help prevent thrush
  • Prime before using for the first time by releasing 2 test sprays into the air
  • Re-prime inhaler if not used for more than 2 weeks

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients 6 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Flunisolide Placebo
Pharyngitis 16.8% 13.2%
Sinusitis 8.8% 5.5%
Allergic reaction 4.4% 2.3%
Upset stomach 3.5% 1.4%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - flunisolide is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to flunisolide

Precautions / Contraindications

  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively

Fluticasone (ArmonAir®)

Dosage forms

RespiClick powder inhaler
  • RespiClick® 55 - delivers 55 mcg of fluticasone propionate per inhalation
  • RespiClick® 113 - delivers 113 mcg of fluticasone propionate per inhalation
  • RespiClick® 232 - delivers 232 mcg of fluticasone propionate per inhalation
  • Each inhaler contains 60 actuations

Dosing

Asthma (≥ 12 years)
  • Starting: 55 mcg twice daily
  • Maintenance: 55 - 232 mcg twice daily
  • Max: 232 mcg twice daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time each day
  • Patients switching from other inhaled corticosteroids may require higher starting doses

Efficacy


Generic / Price

- NO/$$$$

Other

  • Inhaler does not require priming
  • Never wash or put any part of the inhaler in water
  • Do not use with a spacer or volume holding chamber

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients ≥ 12 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Fluticasone 232 mcg Placebo
Nasopharyngitis 4.8% 4.4%
Upper respiratory infection 5.5% 4.8%
Oral candidiasis 4.8% 0.7%
Headache 4.8% 4.4%
Cough 3.4% 2.6%
Other
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone

Precautions / Contraindications

  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections and serious infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.) and/or serious systemic infections
  • Hypersensitivity reactions - serious hypersensitivity reactions including anaphylaxis have occurred with ICS
  • Paradoxical bronchospasm - paradoxical bronchospasm may occur after dosing
  • Eosinophilic Conditions and Churg-Strauss Syndrome - In rare cases, ICS use has been associated with eosinophilic conditions and Churg-Strauss Syndrome. Symptoms include eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy.
  • Liver disease - systemic exposure is likely increased. Use with caution.
  • Kidney disease - has not been studied

Fluticasone (Arnuity Ellipta®)

Dosage forms

Inhalation powder
  • Arnuity™ Ellipta® 100 - delivers 100 mcg of fluticasone furoate per inhalation
  • Arnuity™ Ellipta® 200 - delivers 200 mcg of fluticasone furoate per inhalation
  • Inhaler contains 30 doses

Dosing

Asthma (≥ 12 years)
  • Starting: 100 mcg once daily
  • Maintenance: 100 - 200 mcg once daily
  • Max: 200 mcg once daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time every day

Efficacy


Generic / Price

- NO/$$$$

Other

  • Rinsing mouth after use may help prevent thrush
  • Protect from direct heat and sunlight
  • Discard Arnuity™ Ellipta® inhaler 6 weeks after opening foil tray

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients ≥ 12 years of age
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Arnuity Ellipta Placebo
Nasopharyngitis 8% 5%
Bronchitis 7% 6%
Headache 6% 4%
Upper respiratory infection 6% 5%
Pharyngitis 4% 3%
Sinusitis 4% < 1%
Oropharyngeal pain 3% 0%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone

Precautions / Contraindications

  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - systemic exposure is increased; use with caution in moderate-to-severe liver disease
  • Kidney disease - no dose adjustment necessary

Fluticasone (Flovent®)

Dosage forms

Flovent® HFA inhaler
  • Flovent® 44 - 44 mcg per actuation
  • Flovent® 110 - 110 mcg per actuation
  • Flovent® 220 - 220 mcg per actuation
  • HFAs have 120 actuations
Flovent® Diskus - inhalation powder
  • Flovent® Diskus 50 - 50 mcg per actuation
  • Flovent® Diskus 100 - 100 mcg per actuation
  • Flovent® Diskus 250 - 250 mcg per actuation
  • Diskus have 60 actuations

Dosing - Flovent HFA

Asthma (4 - 11 years)
  • Dosing: 88 mcg twice a day
Asthma (12 years and older)
  • Starting: 88 mcg twice a day
  • Max: 880 mcg twice a day
  • Maximum benefit seen after 2 weeks

Dosing - Flovent Diskus

Asthma (4 - 11 years)
  • Starting: 50 mcg twice a day
  • Max: 100 mcg twice a day
  • Maximum benefit seen after 2 weeks
Asthma (12 years and older)
  • Starting: 100 mcg twice a day
  • Max: 1000 mcg twice a day
  • Maximum benefit seen after 2 weeks

Efficacy


Generic / Price

- NO/$$$-$$$$

Other

Flovent® HFA
  • Shake well before using
  • Rinsing mouth after use may help prevent thrush
  • Prime before using for the first time by releasing 4 test sprays into the air
  • Re-prime inhaler with 1 test spray if not used for more than 7 days or if dropped
Flovent® Diskus
  • Protect from light
  • Rinsing mouth after use may help prevent thrush
  • Diskus should be discarded 6 weeks (50 mcg strength) or 2 months (100 and 250 mcg strengths) after removal from the moisture-protective foil pouch

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients 4 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Flovent HFA Placebo
Upper respiratory infection 16% 14%
Throat irritation 8% 5%
Sinusitis 7% 3%
Headache 7% 6%
Upper respiratory infection 16% 14%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - fluticasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to fluticasone

Precautions / Contraindications

  • Severe milk allergy - (Flovent Diskus® only) - DO NOT USE - contains small amount of lactose
  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively

Mometasone (Asmanex®)

Dosage forms

Asmanex® HFA
  • Asmanex® HFA 50 mcg
  • Asmanex® HFA 100 mcg
  • Asmanex® HFA 200 mcg
  • Each inhaler delivers 120 actuations
Asmanex Twisthaler® - inhalation powder
  • Asmanex® 110 - 100 mcg per actuation
  • Asmanex® 220 - 200 mcg per actuation
  • Asmanex® 110 - 30 actuation inhaler
  • Asmanex® 220 - 30, 60, and 120 actuation inhalers

Dosing - HFA

Asthma (5 - 11 years old)
  • Dosing: 2 inhalations of 50 mcg HFA twice daily
  • Max: 200 mcg/day
Asthma (≥ 12 years)
  • Starting: 200 mcg twice daily
  • Max: 800 mcg/day
  • If receiving chronic oral corticosteroids, recommended dosing is 400 mcg twice daily
  • Titrate dose at intervals of 2 weeks

Dosing - Twisthaler

Asthma (4 - 11 years)
  • Dosing: 110 mcg once daily in the evening
  • Max: 110 mcg/day
Asthma (≥ 12 years)
  • Starting: 220 mcg once daily in the evening
  • Max: 440 mcg/day
  • If receiving chronic oral corticosteroids, recommended dosing is 440 mcg twice daily
  • Titrate dose at intervals of 2 weeks

Generic / Price

- NO/$$$$

Other

  • Rinsing mouth after use may help prevent thrush
  • Discard the twisthaler 45 days after opening the foil pouch

Mechanism of action

  • Corticosteroid - has multiple anti-inflammatory effects; inhibits both inflammatory cells and release of inflammatory mediators

FDA-approved indications

Asthma
  • Patients 4 years of age and older
  • ICS are indicated for maintenance and prophylactic therapy
  • NOTE: ICS are NOT indicated for the relief of acute bronchospasm

Side effects



Side effect Mometasone Placebo
Headache 17% 20%
Allergic rhinitis 11% 13%
Pharyngitis 8% 7%
Upper respiratory infection 8% 7%
Sinusitis 6% 5%
Other
  • Thrush - up to 34% of patients
  • Voice disorders - up to 50% of patients
  • Reflex cough and bronchospasm


Drug interactions

  • CYP3A4 strong inhibitors - mometasone is a CYP3A4 substrate. Strong CYP3A4 inhibitors may increase systemic exposure to mometasone

Precautions / Contraindications

  • Severe milk allergy - DO NOT USE - contains small amount of lactose
  • Linear growth in children - long-term ICS use in children may inhibit linear growth. See linear growth in children for more.
  • Glaucoma - long-term ICS use may be associated with a higher risk of glaucoma
  • Cataracts - long-term ICS use may be associated with a higher risk of cataracts
  • Osteoporosis - long-term ICS use may be associated with a higher risk of osteoporosis
  • Hypothalamic-pituitary-adrenal (HPA) suppression - ICS may suppress the HPA axis. This is rare at typical doses.
  • Lung infections - Use with caution in patients with serious lung infections (e.g. tuberculosis, fungal infections, etc.)
  • Skin thinning and bruising - long-term ICS use may be associated with skin thinning and bruising
  • Liver disease - has not been studied extensively
  • Kidney disease - has not been studied extensively



Advair® | Wixela Inhub® (fluticasone + salmeterol)

Dosage forms

Inhalation powder (Advair® Diskus | Wixela Inhub®)
  • Strength is expressed as fluticasone/salmeterol
  • Advair® 100/50 - 100/50 mcg per inhalation
  • Advair® 250/50 - 250/50 mcg per inhalation
  • Advair® 500/50 - 500/50 mcg per inhalation
  • Inhalation powder packaged in diskus with 60 doses
HFA (Advair®)
  • Strength is expressed as fluticasone/salmeterol
  • Advair HFA® 45/21 - 45/21 mcg per actuation
  • Advair HFA® 115/21 - 115/21 mcg per actuation
  • Advair HFA® 230/21 - 230/21 mcg per actuation
  • Inhaler with 120 actuations per inhaler

Dosing - Diskus

Asthma
  • 4 - 11 years old
    • One inhalation of 100/50 twice daily
  • 12 years of age and older
    • Dose: one inhalation twice daily
    • Starting: strength will depend on asthma severity
    • Max dose: 500/50, one inhalation twice daily
    • Maximum benefit seen after 2 weeks
COPD
  • 1 inhalation of 250/50 twice daily

Dosing - HFA

Asthma in children ≥ 12 years and adults
  • Dose: two inhalations twice daily
  • Starting: strength will depend on asthma severity
  • Max dose: 230/21, two inhalations twice daily
  • Maximum benefit seen after 2 weeks

Generic / Price

  • Diskus - YES/$$$
  • HFA - NO/$$$$

Other

Advair® HFA
  • Shake well for 5 seconds before use
  • Prime before using for the first time by releasing 4 test sprays
  • In cases where the inhaler has not been used for more than 4 weeks or when it has been dropped, prime the inhaler again by releasing 2 test sprays
  • Rinse mouth after use
Advair® Diskus
  • The device should be discarded 1 month after removal from the moisture-protective foil overwrap pouch
  • Rinse mouth after use

FDA-approved indications

Advair® Diskus
  • Asthma in children ≥ 4 years and adults
  • Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm
Advair® HFA
  • Asthma in children ≥ 12 years and adults
  • NOT for relief of acute bronchospasm

AirDuo RespiClick® (fluticasone + salmeterol)

Dosage forms

Powder inhaler (fluticasone/salmeterol)
  • AirDuo RespiClick® 55/14 - 55/14 mcg per inhalation
  • AirDuo RespiClick® 113/14 - 113/14 mcg per inhalation
  • AirDuo RespiClick® 232/14 - 232/14 mcg per inhalation
  • Each inhaler contains 60 actuations

Dosing

Asthma (≥ 12 years old)
  • Starting: 55/14 mcg twice daily
  • Maintenance: 55/14 - 232/14 mcg twice daily
  • Max dose: 232/14 mcg twice daily
  • Increase dose at intervals of 2 weeks
  • Inhale at the same time each day
  • Patients switching from other inhaled corticosteroids may require higher starting doses

Generic / Price

- YES/$$

Other

  • Inhaler does not require priming
  • Never wash or put any part of the inhaler in water
  • Do not use with a spacer or volume holding chamber

FDA-approved indications

  • Asthma in children ≥ 12 years and adults
  • NOT for relief of acute bronchospasm

Breo Ellipta® (fluticasone + vilanterol)

Dosage forms

Inhaler
  • Inhaler delivers 100 mcg of fluticasone powder and 25 mcg of vilanterol powder per inhalation
  • Inhaler comes with 30 inhalations

Dosing

COPD
  • One inhalation once daily
Asthma (≥ 18 years old)
  • One inhalation once daily

Generic / Price

- NO/$$$$

Other

  • See Breo Ellipta® PI for complete prescribing information
  • Discard inhaler 6 weeks after opening the foil tray
  • DO NOT USE in patients with severe milk allergy
  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.

FDA-approved indications

  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma in patients ≥ 18 years old that is not well-controlled with other medications
  • NOT for relief of acute bronchospasm

Dulera® (mometasone + formoterol)

Dosage forms

Inhaler (mometasone/formoterol)
  • Dulera® 50/5 - 50 mcg/5 mcg per actuation
  • Dulera® 100/5 - 100 mcg/5 mcg per actuation
  • Dulera® 200/5 - 200 mcg/5 mcg per actuation
  • Comes in inhaler with 120 actuations

Dosing

Asthma
  • 5 - 11 years old
    • Dosing: 2 inhalations of 50 mcg/5 mcg twice daily
    • Max daily dose: 200 mcg/20 mcg
  • ≥ 12 years old
    • Dosing: 2 inhalations twice daily
    • Medium-dose corticosteroids: Dulera® 100 mcg/5 mcg, two inhalations twice daily
    • High-dose corticosteroids: Dulera® 200 mcg/5 mcg, two inhalations twice daily
    • Max daily dose: 800 mcg/20 mcg
    • Maximum benefit seen after 2 weeks

Generic / Price

- NO/$$$$

Other

  • Shake well before use
  • Prime inhaler by releasing 4 test sprays
  • Re-prime if not used for ≥ 5 days

FDA-approved indications

  • Maintenance treatment of Asthma
  • NOT for relief of acute bronchospasm

Symbicort® (budesonide + formoterol)

Dosage forms

Inhaler (budesonide/formoterol)
  • Symbicort® 80/4.5 - 80 mcg/4.5 mcg per actuation
  • Symbicort® 160/4.5 - 160 mcg/4.5 mcg per actuation
  • Comes in inhaler with 120 actuations

Dosing

Asthma
  • 6 to 11 years old
    • Dose: Symbicort 80/4.5 two inhalations twice daily
  • ≥ 12 years old
    • Dose: two inhalations twice daily
    • Starting - may start with 80/4.5 or 160/4.5, depending on severity
    • Max: Symbicort 160/4.5 two inhalations twice daily
    • Maximum benefit seen after 2 weeks
COPD
  • Symbicort 160/4.5 two inhalations twice daily

Generic / Price

- NO/$$$$

Other

  • Shake well for 5 seconds before use
  • Inhaler is good for 3 months after removal from foil pouch
  • If you do not use your inhaler for more than 7 days or if you drop it, you will need to prime again
  • See patient instructions for details

FDA-approved indications

  • Maintenance treatment of Asthma
  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm



Trelegy Ellipta® (fluticasone + vilanterol + umeclidinium)

Dosage forms

Inhalation powder
  • Inhaler delivers 100 mcg of fluticasone, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol powder per inhalation
  • Inhaler comes with 30 inhalations

Dosing

COPD
  • One inhalation once daily

Generic / Price

- NO/$$$$

Other

  • See Trelegy Ellipta® PI for complete prescribing information
  • Discard inhaler 6 weeks after opening the foil tray
  • DO NOT USE in patients with severe milk allergy
  • Vilanterol is a CYP3A4 substrate. Use caution with strong CYP3A4 inhibitors.

FDA-approved indication

  • Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • NOT for relief of acute bronchospasm









Pricing legend
  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability