Inhaled Corticosteroids (ICS) | (See Table 9–4) |
Systemic Corticosteroids | (Applies to all three corticosteroids) |
Methylprednisolone | 2-, 4-, 6-, 8-, 16-, 32-mg tablets | 40–60 mg | 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 two 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. |
Prednisolone | 5-mg tablets; 5 mg/5 mL, 15 mg/5 mL oral solution | 40–60 mg |
Prednisone | 1-, 2.5-, 5-, 10-, 20-, 50-mg tablets; 5 mg/mL oral solution | 7.5–60 mg |
Inhaled LABA | Should not be used for symptom relief or exacerbations. Use with inhaled corticosteroids. |
Formoterol | Inhalation: 20 mcg/2 mL nebulizer (DPI discontinued by FDA in United States) | 20 mcg 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. |
Salmeterol | DPI: 50 mcg/actuation | 1 blister every 12 hours |
Combined Medication |
Budesonide/formoterol | HFA MDI: 80 mcg/4.5 mcg 160 mcg/4.5 mcg | 2 inhalations twice daily; dose depends on severity of asthma | |
Fluticasone/salmeterol | DPI: 100 mcg/50 mcg 250 mcg/50 mcg 500 mcg/50 mcg HFA: 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 | DPI: 100 mcg/25 mcg or 200 mcg/25 mcg per blister | 1 puff inhaled daily | |
Mometasone/formoterol | 100 mcg/5 mcg/spray 200 mcg/5 mcg/spray | 2 inhalations twice daily | |
Cromolyn and Nedocromil |
Cromolyn | MDI: 0.8 mg/puff Nebulizer: 20 mg/ampule | 2 puffs four times daily 1 ampule four times daily | 4- to 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. |
Nedocromil | MDI: 1.75 mg/puff | 2 puffs four times daily |
Inhaled Long-Acting Anticholinergic | Should not be used for symptom relief or exacerbations. Use with ICS. |
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 | |
Methylxanthines |
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. |