Inhaled Short-Acting Beta-2-Agonists (SABA) |
Albuterol CFC | MDI: 90 mcg/puff, 200 puffs/canister | 2 puffs 5 minutes before exercise 2 puffs every 4–6 hours as needed | An increasing use or lack of expected effect indicates diminished control of asthma. Not recommended for long-term daily treatment. Regular use exceeding 2 days/week for symptom control (not prevention of EIB) indicates the need to step up therapy. Differences in potency exist, but all products are essentially comparable on a per-puff basis. May double usual dose for mild exacerbations. Prime the inhaler by releasing four actuations prior to use. Periodically clean HFA activator, as drug may block/plug orifice. |
Albuterol HFA | MDI: 90 mcg/puff, 200 puffs/canister | 2 puffs 5 minutes before exercise 2 puffs every 4–6 hours as needed |
Pirbuterol CFC | MDI: 200 mcg/puff, 400 puffs/canister | 2 puffs 5 minutes before exercise 2 puffs every 4–6 hours as needed |
Levalbuterol HFA | MDI: 45 mcg/puff, 200 puffs/canister | 2 puffs 5 minutes before exercise 2 puffs every 4–6 hours as needed |
Albuterol | Nebulizer solution: 0.63 mg/3 mL 1.25 mg/3 mL 2.5 mg/3 mL 5 mg/mL (0.5%) | 1.25–5 mg in 3 mL of saline every 4–8 hours as needed | |
Levalbuterol (R-albuterol) | Nebulizer solution: 0.31 mg/3 mL 0.63 mg/3 mL 1.25 mg/0.5 mL 1.25 mg/3 mL | 0.63–1.25 mg every 8 hours as needed | |
Anticholinergics |
Ipratropium HFA | MDI: 17 mcg/puff, 200 puffs/canister | 2–3 puffs every 6 hours | |
| Nebulizer solution: 0.25 mg/mL (0.025%) | 0.25 mg every 6 hours | |
Ipratropium with albuterol | MDI: 18 mcg/puff of ipratropium bromide and 90 mcg/puff of albuterol, 200 puffs/canister | 2–3 puffs every 6 hours | |
| Nebulizer solution: 0.5 mg/3 mL ipratropium bromide and 2.5 mg/3 mL albuterol | 3 mL every 4–6 hours | |
Systemic Corticosteroids |
Methylprednisolone | 2-, 4-, 6-, 8-, 16-, 32-mg tablets | 40–60 mg/day as single or 2 divided doses | Short courses or “bursts” are effective for establishing control when initiating therapy or during a period of gradual deterioration. The burst should be continued until symptoms resolve and the PEF is at least 80% of personal best. This usually requires 3–10 days but may require longer. There is no evidence that tapering the dose following improvements prevents relapse. |
Prednisolone | 5-mg tablets; 5 mg/5 mL, 15 mg/5 mL oral solution | 40–60 mg/day as single or 2 divided doses | |
Prednisone | 1-, 2.5-, 5-, 10-, 20-, 50-mg tablets; 5 mg/mL oral solution | 40–60 mg/day as single or 2 divided doses | |
Methylprednisolone acetate | Repository injection: 40 mg/mL 80 mg/mL | 240 mg intramuscularly once | |