|Inhaled Corticosteroids ||(See Table 9–4) |
|Systemic Corticosteroids ||(Applies to all three corticosteroids) |
2-, 4-, 6-, 8-, 16-, 32-mg tablets
5-mg tablets; 5 mg/5 mL, 15 mg/5 mL oral solution
1-, 2.5-, 5-, 10-, 20-, 50-mg tablets; 5 mg/mL oral solution
Administer single dose in AM either daily or on alternate days (alternate-day therapy may produce less adrenal suppression) as needed for control.
Short courses or “bursts” as single or 2 divided doses for 3–10 days are effective for establishing control when initiating therapy or during a period of gradual deterioration.
There is no evidence that tapering the dose following improvement in symptom control and pulmonary function prevents relapse.
|Inhaled Long-Acting Beta-2-Agonists ||Should not be used for symptom relief or exacerbations. Use with inhaled corticosteroids. |
Inhalation 20 mcg/2 mL neb (DPI discontinued by FDA in United States)
DPI 50 mcg/actuation
20 mcg every 12 hours
1 blister every 12 hours
Additional doses should not be administered for at least 12 hours.
Agents should be used only with their specific inhaler and should not be taken orally.
Decreased duration of protection against EIB may occur with regular use.
|Combined Medication |
|Budesonide/formoterol || |
80 mcg/4.5 mcg
160 mcg/4.5 mcg
|2 inhalations twice daily; dose depends on severity of asthma || |
|Fluticasone/salmeterol || |
100 mcg/50 mcg
250 mcg/50 mcg, or
500 mcg/50 mcg
45 mcg/21 mcg
115 mcg/21 mcg
230 mcg/21 mcg
|1 inhalation twice daily; dose depends on severity of asthma || |
|Fluticasone furoate/vilanterol ||100 mcg/25 mcg, 200 mcg/25 mcg per blister DPI ||1 puff inhaled daily || |
|Mometasone/formoterol || |
100 mcg/5 mcg/spray
200 mcg/5 mcg/spray
|2 inhalations twice daily || |
|Cromolyn and Nedocromil |
2 puffs four times daily
1 ampule four times daily
2 puffs four times daily
4–6 week trial may be needed to determine maximum benefit.
Dose by MDI may be inadequate to affect hyperresponsiveness.
One dose before exercise or allergen exposure provides effective prophylaxis for 1–2 hours. Not as effective for EIB as SABA.
Once control is achieved, the frequency of dosing may be reduced.
|Inhaled Long-Acting Anticholinergic ||Should not be used for symptom relief or exacerbations. Use with inhaled corticosteroids. |
|Tiotropium ||DPI 18 mcg/blister ||1 blister daily || |
|Leukotriene Modifiers |
|Leukotriene Receptor Antagonists |
|Montelukast ||4- or 5-mg chewable tablet; 10-mg tablet ||10 mg daily at bedtime || |
|Zafirlukast ||10- or 20-mg tablet ||20-mg tablet twice daily || |
|5-Lipoxygenase Inhibitor |
|Zileuton ||600-mg tablet ||600 mg four times daily || |
|Theophylline ||Liquids, sustained-release tablets, and capsules ||Starting dose 10 mg/kg/day up to 300 mg maximum; usual maximum dose 800 mg/day || |
Adjust dose to achieve serum concentration of 5–15 mcg/mL after at least 48 hours on same dose.
Due to wide interpatient variability in theophylline metabolic clearance, routine serum theophylline level monitoring is important.