Controller medications - ICS (inhaled corticosteroids)

Question 1

Beclomethasone (Qvar)
Dosage form

Answer 1

Redihaler (MDI)

Question 2

Beclomethasone (Qvar)
Dosing ages

Answer 2

No dosing for ages 0-4 years old
Dosing in 5-11 Years old
- 40-80mcg inhaled BID
Adult dosing
- 40-320mcg inhaled twice daily

Question 3

Budesonide (pulmicort respules)
Dosing form

Answer 3

Nebulizer solution

Question 4

Budesonide (pulmicort respules)
Dosing ages

Answer 4

Dosing in ages 0-4 years old
- 0.25-1mg/day once daily or divided twice daily
Dosing in ages 5-11 years old
- 0.5-2mg/day once daily or divided BID

Question 5

Budesonide (pulmicort)
Dosage form

Answer 5

Flexhaler

Question 6

Budesonide (pulmicort)
Dosing ages

Answer 6

No dosing for ages 0-4 years old
Dosing in 5-11 years old
- 90-360mcg inhaled BID
Adult dosing
- 90-720mcg inhaled BID

Question 7

Ciclesonide (alvesco)
Dosage form

Answer 7

HFA

Question 8

Ciclesonide (alvesco)
Dosing age

Answer 8

No dosing in 0-4 years old
Dosing in ages 5-11 years old
- (greater than or equal to 6) 80-160mcg daily
Adult dosing
- 80-320mcg inhaled twice daily

Question 9

Fluticasone Propionate (Flovent) (armonair dig-inhaler)
Dosage forms

Answer 9

HFA, DPI, aerosol powder inhaler

Question 10

Fluticasone Propionate (Flovent) (armonair dig-inhaler)
Dosing ages

Answer 10

Dosing in 0-4 years old
- HFA - (greater than or equal to 4) 88mcg twice daily
- DPI - (greater than or equal to 4) 50mcg twice daily
Dosing in 5-11 years old
- HFA - 44-88mcg twice daily
- HFA - 50-100 mcg inhaled twice daily
Adult dosing
- HFA 44-220mcg inhaled BID
- DPI - 50- 250 inhaled BID
-MDPI - 55-232mcg inhaled BID

Question 11

Fluticasone Furoate (arnuity ellipta)
Dosage form

Answer 11

Ellipta

Question 12

Fluticasone Furoate (arnuity ellipta)
Dosing ages

Answer 12

No dosing in ages 0-4 years old
Dosing in ages 5-11 years old
- 50mcg once daily
Adult dosing
- 100-200mcg inhaled twice daily

Question 13

Mometasone
(asmanex)
Dosage form

Answer 13

HFA and twisthaler

Question 14

Mometasone (asmanex)
dosing age

Answer 14

No dosing in ages 0-4 years old
Dosing for ages 5-11 years old
- HFA- 100mcg twice daily
-Twisthaler- (4-11yo) 110mcg once daily in the evening
Dosing in adults
- HFA- 200- 400 mcg twice daily
- Twisthaler - 110- 880mcg once daily in the evening

Question 15

Adverse effects and counseling tips for all ICS

Answer 15

AE: Oral thrush (candidiasis), cough, dysphonia

*Counseling tip: patients should rinse their mouth
and spit after use to prevent oral thrush
* Inhaled corticosteroids (ICSs) are the most effective
long-term control therapy for asthma (improve quality of life, increase lung function, and reduce the risk of exacerbations)
* ICSs may increase the risk of pneumonia in patients with COPD
* Titrate to lowest effective dose- see low, medium, and high dose conversion table
* Pulmicort Respules should use Jet Nebulizer and should not be mixed with other nebulizer medications
* High doses increase the risk of systemic side effects
* See steroid potency chart at the end for dosing