Available inhaled steroids include:
beclomethasone - Beclovent®, Vanceril®
flunisolide - AeroBid®
triamcinolone - Azmacort®

Prednisone, Medrol, Hydrocortisone

 

 


Treatment Updates - A Clinical Series for Physicians

Inhaled Corticosteroids
Medical Consultant: Elizabeth Brown, MD
Medical Editor: Mark Evans, PhD, Director of Multimedia CME, American Medical Association
Clinical Editor: Ronald Ferdman, MD, Division of Clinical Immunology & Allergy, Children's Hospital Los Angeles
June 1997

Inhaled corticosteroids have been recommended as the primary maintenance therapy in patients with moderate and severe persistent asthma. Recognition of the importance of inflammation in the pathogenesis of asthma has led to the recommendation for the early use of inhaled corticosteroids to treat persistent asthma. Corticosteroids exert multiple effects on the pathogenesis of inflammation, including interference with arachidonic acid metabolism and the synthesis of leukotrienes and prostaglandins, prevention of the directed migration and activation of inflammatory cells, and increased responsiveness of beta2-receptors of airway smooth muscle. The clinical effects of corticosteroids include reduction in severity of symptoms, improvement in peak expiratory flow and spirometry, diminished airway hyperresponsiveness, prevention of exacerbations and possibly the prevention of lung remodeling.

The development of inhaled preparations of corticosteroids that are highly active topically, with a relatively low-incidence of side effects, was a major advance in asthma therapy. The generic names of currently available inhaled corticosteroids are beclomethasone, flunisolide, fluticasone, and triamcinolone. The table below profiles the recommended dosages of inhaled corticosteroids. Dosages vary with different preparations because differences exist in the amount of medication delivered per actuation and in the relative potency of each formulation. Beclomethasone diproprionate inhalers dispense 42 mcg per actuation, flunisolide inhalers dispense 250 mcg per inhalation, and triamcinolone inhalers dispense 100 mcg per inhalation. Fluticasone inhalers come in three strengths: 44 mcg, 110 mcg and 220 mcg.

Estimated Comparative Daily Dosages for Inhaled Corticosteroids

ADULTS

Drug Low Dose Medium Dose High Dose
Beclomethasone dipropionate 42 mcg/puff 84 mcg/puff 168-504 mcg (4-12 puffs - 42 mcg) (2-6 puffs - 84 mcg) 504-840 mcg (12-20 puffs - 42 mcg) (6-10 puffs - 84 mcg) >840 mcg (>20 puffs - 42 mcg) (>10 puffs - 84 mcg)
Budesonide Turbuhaler 200 mcg/dose 200-400 mcg (1-2 inhalations) 400-600 mcg (2-3 inhalations) >600 mcg (>3 inhalations)
Flunisolide 250 mcg/puff 500-1,000 mcg (2-4 puffs) 1,000-2,000 mcg (4-8 puffs) >2,000 mcg (>8 puffs)
Fluticasone MDI: 44, 110, 220 mcg/puff DPI: 50, 100, 250 mcg/dose 88-264 mcg (2-6 puffs - 44 mcg) or (2 puffs - 110 mcg) (2-6 inhalations - 50 mcg) 264-660 mcg (2-6 puffs - 110 mcg) (3-6 inhalations - 100 mcg) >660 mcg (>6 puffs - 110 mcg) or (>3 puffs - 220 mcg) (>6 inhalations - 100 mcg)
Triamcinolone acetonide 100 mcg/puff 400-1,000 mcg (4-10 puffs) 1,000-2,000 mcg (10-20 puffs) >2,000 mcg (>20 puffs)

CHILDREN

Drug Low Dose Medium Dose High Dose
Beclomethasone dipropionate 42 mcg/puff 84 mcg/puff 84-336 mcg (2-8 puffs) 336-672 mcg (8-16 puffs) >672 mcg (>16 puffs)
Budesonide Turbuhaler 200 mcg/dose 100-200 mcg 200-400 mcg (1-2 inhalations - 200 mcg) >400 mcg (>2 inhalations - 200 mcg)
Flunisolide 250 mcg/puff 500-750 mcg (2-3 puffs) 1,000-1,250 mcg (4-5 puffs) >1,250 mcg (>5 puffs)
Fluticasone MDI: 44, 110, 220 mcg/puff DPI: 50, 100, 250 mcg/dose 88-176 mcg (2-4 puffs - 44 mcg) (2-4 inhalations - 50 mcg) 176-440 mcg (4-10 puffs - 44 mcg) or (2-4 puffs - 110 mcg) (2-4 inhalations - 100 mcg) >440 mcg (>4 puffs - 110 mcg) (>4 inhalations - 100 mcg)
Triamcinolone acetonide 100 mcg/puff 400-800 mcg (4-8 puffs) 800-1,200 mcg (8-12 puffs) >1,200 mcg (>12 puffs)

http://www.ama-assn.org/special/asthma/treatmnt/updates/inhaled.htm