Inhaled Corticosteroid Dose Comparison in Asthma
First Line Second Line Specialist Hospital Only
BDP = Beclometasone dipropionate; ICS = Inhaled corticosteroid; LABA = Long-acting beta-agonist; pMDI = Pressurised metered dose inhaler; BAI = Breath actuated (aerosol) inhaler; DPI = Dry powder inhaler
Kelhale and Qvar have extrafine BDP particles, and are more potent than traditional BDP CFC-containing inhalers; Kelhale and Qvar are approximately twice as potent as Clenil Modulite.
Fostair (pMDI), Fostair NEXThaler (DPI) and Luforbec (pMDI) have extrafine particles. The manufacturer states that 100 micrograms of BDP extrafine in these preparations is equivalent to 250 micrograms of BDP in a non-extrafine formulation.
Relvar Ellipta (DPI): fluticasone furoate in Relvar Ellipta has a higher potency compared to fluticasone propionate used in some other products; doses are not interchangeable. The manufacturer's Summary of Product Characteristics (SPC) states that in patients with asthma, fluticasone furoate 100 micrograms once daily is approximately equivalent to fluticasone propionate 250 micrograms twice daily.
The dosage equivalents shown below are approximate and will depend on other factors such as inhaler technique. The very low, low, medium and high dose ICS categories have been taken from the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidance Network (SIGN) British guideline on the management of asthma (2019). Doses are presented in comparison to standard BDP equivalency per day.
Different products and doses are licensed for different age groups and some may be applicable only to older children or adults (aged 18 years and over). Prior to prescribing, the relevant Summary of Product Characteristics (SPC) should be checked.
The NHS Devon Medicines Optimisation Team has produced additional resources to support greener respiratory care across Devon (see here).
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200 micrograms BDP equivalent per day
ICS monotherapy inhaler
Budesonide
- Easyhaler Budesonide (DPI) 100 micrograms – 1 puff twice a day
- Pulmicort Turbohaler(DPI) 100 micrograms – 1 puff twice a day
Beclometasone dipropionate
- Clenil Modulite (pMDI) 50 micrograms – 2 puffs twice a day
Fluticasone propionate
- Flixotide Accuhaler (DPI) 50 micrograms – 1 puff twice a day
- Flixotide Evohaler (pMDI) 50 micrograms – 1 puff twice a day
Combination ICS/LABA inhalers
Budesonide / formoterol
- Symbicort Turbohaler (DPI) 100/6 – 1 puff twice a day
400 micrograms BDP equivalent per day
ICS monotherapy inhaler
Budesonide
- Easyhaler Budesonide (DPI)
- 100 micrograms – 2 puffs twice a day
- 200 micrograms – 1 puff twice a day
- Pulmicort Turbohaler (DPI)
- 100 micrograms – 2 puffs twice a day
- 200 micrograms – 1 puff twice a day
Beclometasone dipropionate
- Kelhale (pMDI) (extrafine) 50 micrograms – 2 puffs twice a day
- Kelhale is licensed only for adults over 18 years of age
- Qvar (pMDI or BAI) (extrafine) 50 micrograms – 2 puffs twice a day
- Clenil Modulite (pMDI) 100 micrograms – 2 puffs twice a day
Fluticasone propionate
- Flixotide Accuhaler(DPI) 100 micrograms – 1 puff twice a day
- Flixotide Evohaler (pMDI) 50 micrograms – 2 puffs twice a day
Combination ICS/LABA inhalers
Budesonide / formoterol
- Fobumix Easyhaler (DPI)
- 80/4.5 – 2 puffs twice a day
- 160/4.5 – 1 puff twice a day
- Note: Fobumix Easyhaler is licensed only for adults aged 18 years and above
- Symbicort Turbohaler (DPI)
- 100/6 – 2 puffs twice a day
- 200/6 – 1 puff twice a day
- DuoResp Spiromax (DPI) 160/4.5 – 1 puff twice a day
- Note: DuoResp Spiromax is included in the formulary only for adults aged 18 years and above
Fluticasone propionate / salmeterol
- Seretide Accuhaler (DPI) 100/50 – 1 puff twice a day
- Avenor (pMDI) 50/25 - 2 puffs twice a day
500 micrograms BDP equivalent per day
Combination ICS/LABA inhalers
Beclometasone dipropionate (extrafine) / formoterol
- Fostair NEXThaler (DPI) 100/6 – 1 puff twice a day
- Note: Fostair NEXThaler is licensed only for adults aged 18 years and above
- Luforbec (pMDI) 100/6 – 1 puff twice a day
- Note: Luforbec is licensed only for adults aged 18 years and above
Medium dose ICS should only be used in children aged 12 years and under after referring the patient to secondary care.
800 micrograms BDP equivalent per day
ICS monotherapy inhaler
Budesonide
- Easyhaler Budesonide (DPI)
- 200 micrograms – 2 puffs twice a day
- 400 micrograms – 1 puff twice a day
- Pulmicort Turbohaler(DPI)
- 200 micrograms – 2 puffs twice a day
- 400 micrograms – 1 puff twice a day
Beclometasone dipropionate
- Kelhale (pMDI) (extrafine) 100 micrograms – 2 puffs twice a day
- Kelhale is licensed only for adults over 18 years of age
- Qvar (pMDI or BAI) (extrafine) 100 micrograms – 2 puffs twice a day
- Clenil Modulite(pMDI) 200 micrograms - 2 puffs twice a day
Combination ICS/LABA inhalers
Budesonide / formoterol
- Fobumix Easyhaler (DPI)
- 160/4.5 – 2 puffs twice a day
- 320/9 – 1 puff twice a day
- Note: Fobumix Easyhaler is licensed only for adults aged 18 years and above
- Symbicort Turbohaler (DPI)
- 200/6 – 2 puffs twice a day
- 400/12 – 1 puff twice a day
- DuoResp Spiromax(DPI)
- 160/4.5 – 2 puffs twice a day
- 320/9 – 1 puff twice a day
- Note: DuoResp Spiromax is included in the formulary only for adults aged 18 years and above
1000 micrograms BDP equivalent per day
ICS monotherapy inhaler
Fluticasone propionate
- Flixotide Accuhaler (DPI) 250 micrograms – 1 puff twice a day
- Flixotide Evohaler (pMDI) 125 micrograms – 2 puffs twice a day
Combination ICS/LABA inhalers
Beclometasone dipropionate (extrafine) / formoterol
Note: BTS/SIGN classifies BDP 1000 micrograms equivalent/day as a high dose corticosteroid when given as Clenil Modulite but a medium dose corticosteroid when given as BDP extrafine in combination with formoterol as Fostair NEXThaler.
- Fostair NEXThaler (DPI) 100/6 – 2 puffs twice a day
- Note: Fostair NEXThaler is licensed only for adults aged 18 years and above
- Luforbec (pMDI) 100/6 – 2 puffs twice a day
- Note: Luforbec is licensed only for adults aged 18 years and above
Fluticasone propionate / salmeterol
- Fusacomb Easyhaler (DPI) 250/50 – 1 puff twice a day
- Seretide Accuhaler(DPI) 250/50 – 1 puff twice a day
- Avenor (pMDI) 125/25 – 2 puffs twice a day
High dose ICS should only be used after referring the patient to secondary care.
High dose pMDI inhaled corticosteroid devices should be prescribed with a spacer to reduce risk of oral candidiasis.
1000 micrograms BDP equivalent per day
ICS monotherapy inhaler
Beclometasone dipropionate
Note: BTS/SIGN classifiees BDP 1000 micrograms equivalent/day as a high dose corticosteroid when given as Clenil Modulite but a medium dose corticosteroid when given as BDP extrafine in combination with formoterol as Fostair NEXThaler.
- Clenil Modulite (pMDI) 250 micrograms – 2 puffs twice a day
1600 micrograms BDP equivalent per day
ICS monotherapy inhaler
Budesonide
- Easyhaler Budesonide(DPI) 400 micrograms – 2 puffs twice a day
- Pulmicort Turbohaler(DPI) 400 micrograms – 2 puffs twice a day
Beclometasone dipropionate
- Kelhale (pMDI) (extrafine) 100 micrograms – 4 puffs twice a day
- Qvar(pMDI or BAI) (extrafine) 100 micrograms – 4 puffs twice a day
Combination ICS/LABA inhalers
Budesonide / formoterol
- Fobumix Easyhaler (DPI) 320/9 – 2 puffs twice a day
- Symbicort Turbohaler (DPI) 400/12 – 2 puffs twice a day
- DuoResp Spiromax (DPI) 320/9 – 2 puffs twice a day
2000 micrograms BDP equivalent per day
ICS monotherapy inhaler
Beclometasone dipropionate
- Clenil Modulite(pMDI) 250 micrograms – 4 puffs twice a day
Fluticasone propionate
- Flixotide Accuhaler (DPI) 500 micrograms – 1 puff twice a day
- Flixotide Evohaler (pMDI) 250 micrograms – 2 puffs twice a day
Combination ICS/LABA inhalers
Beclometasone dipropionate (extrafine) / formoterol
- Fostair NEXThaler (DPI) 200/6 – 2 puffs twice a day
- Luforbec(pMDI) 200/6 – 2 puffs twice a day
Fluticasone propionate / salmeterol
- AirFluSal Forspiro (DPI) 500/50 – 1 puff twice a day
- Avenor (pMDI) 250/25 - 2 puffs twice a day
