Inhaled drugs for asthma in adults and adolescents: formulation and device summary

For a summary of inhaled drugs available in Australia for asthma in adults and adolescents, see:

For information about delivery devices, including links to videos and patient handouts, see Inhalational drug delivery devices. See also the National Asthma Council website for a poster of asthma inhalers, including pictures.

Table 1. Inhaled corticosteroid–based inhalers available in Australia for asthma in adults and adolescents

Device

(brand examples) [NB1]

Dose per actuation

Low-dose regimen

Medium-dose regimen

High-dose regimen [NB2]

beclometasone

(Qvar)

50 or 100 micrograms twice daily

200 micrograms twice daily

300 or 400 micrograms twice daily

pMDI

50 micrograms

1 or 2 inhalations twice daily

n/a

n/a

100 micrograms

1 inhalation twice daily

2 inhalations twice daily

3 or 4 inhalations twice daily

breath-activated pMDI

(Autohaler)

50 micrograms

1 or 2 inhalations twice daily

n/a

n/a

100 micrograms

1 inhalation twice daily

2 inhalations twice daily

3 or 4 inhalations twice daily

budesonide

(Pulmicort)

100 or 200 micrograms twice daily

400 micrograms twice daily

600 or 800 micrograms twice daily

maximum 2400 micrograms daily in divided doses

multiple-dose DPI

(Turbuhaler)

100 micrograms

1 or 2 inhalations twice daily

n/a

n/a

200 micrograms

1 inhalation twice daily

2 inhalations twice daily

3 or 4 inhalations twice daily

(maximum 12 inhalations daily)

400 micrograms

n/a

1 inhalation twice daily

2 inhalations twice daily (maximum 6 inhalations daily)

ciclesonide

(Alvesco)

80 or 160 micrograms once daily

320 micrograms once daily

doses above 320 micrograms daily not usually used

pMDI

80 micrograms

1 or 2 inhalations once daily

n/a

n/a

160 micrograms

1 inhalation once daily

2 inhalations once daily

fluticasone furoate

(Arnuity)

n/a [NB3]

100 micrograms once daily

200 micrograms once daily

multiple-dose DPI

(Ellipta)

100 micrograms

n/a

1 inhalation once daily

2 inhalations once daily

200 micrograms

n/a

n/a

1 inhalation once daily

fluticasone propionate

(Flixotide)

50 or 100 micrograms twice daily

125 to 250 micrograms twice daily

500 micrograms twice daily

maximum 1000 micrograms twice daily

pMDI

50 micrograms

1 or 2 inhalations twice daily

n/a

n/a

125 micrograms

n/a

1 or 2 inhalations twice daily

n/a

250 micrograms

n/a

1 inhalation twice daily

2 inhalations twice daily

(maximum 4 inhalations twice daily)

multiple-dose DPI

(Accuhaler)

100 micrograms

1 inhalation twice daily

2 inhalations twice daily

n/a

250 micrograms

n/a

1 inhalation twice daily

2 inhalations twice daily

500 micrograms

n/a

n/a

1 inhalation twice daily

beclometasone+formoterol

(Fostair) [NB4]

100+6 micrograms twice daily

200+12 micrograms twice daily

n/a [NB5]

pMDI

100+6 micrograms

1 inhalation twice daily

2 inhalations twice daily

n/a

budesonide+formoterol

(Symbicort, Duoresp) [NB6]

100+6 to 200+6 micrograms twice daily

400+12 micrograms twice daily

800+24 micrograms twice daily

maximum 2400+72 micrograms daily [NB7]

pMDI

(Rapihaler)

50+3 micrograms

2 inhalations twice daily

n/a

n/a

100+3 micrograms

2 inhalations twice daily

4 inhalations twice daily

n/a

200+6 micrograms [NB8]

1 inhalation twice daily

2 inhalations twice daily

4 inhalations twice daily

multiple-dose DPI

(Turbuhaler, Spiromax)

100+6 micrograms

1 inhalation twice daily

n/a

n/a

200+6 micrograms

1 inhalation twice daily

2 inhalations twice daily

4 inhalations twice daily

400+12 micrograms [NB9]

n/a

1 inhalation twice daily

2 inhalations twice daily

fluticasone furoate+vilanterol

(Breo)

n/a [NB3]

100+25 micrograms once daily

200+25 micrograms once daily

multiple-dose DPI

(Ellipta)

100+25 micrograms

n/a

1 inhalation once daily

n/a

200+25 micrograms

n/a

n/a

1 inhalation once daily

fluticasone propionate+formoterol

(Flutiform)

100+10 micrograms twice daily

250+10 micrograms twice daily

500+20 micrograms twice daily

pMDI

50+5 micrograms

2 inhalations twice daily

n/a

n/a

125+5 micrograms

n/a

2 inhalations twice daily

n/a

250+10 micrograms

n/a

1 inhalation twice daily

2 inhalations twice daily

fluticasone propionate+salmeterol

(Seretide, Pavtide, Cipla, SalplusF)

100+50 micrograms twice daily

250+50 micrograms twice daily

500+50 micrograms twice daily

pMDI

50+25 micrograms

2 inhalations twice daily

n/a

n/a

125+25 micrograms

n/a

2 inhalations twice daily

n/a

250+25 micrograms

n/a

n/a

2 inhalations twice daily

multiple-dose DPI

(Accuhaler)

100+50 micrograms

1 inhalation twice daily

n/a

n/a

250+50 micrograms

n/a

1 inhalation twice daily

n/a

500+50 micrograms

n/a

n/a

1 inhalation twice daily

mometasone+indacaterol

(Atectura)

62.5+125 micrograms once daily

127.5+125 micrograms once daily

260+125 micrograms once daily

single-dose DPI

(Breezhaler)

62.5+125 micrograms

1 inhalation once daily

n/a

n/a

127.5+125 micrograms

n/a

1 inhalation once daily

n/a

260+125 micrograms

n/a

n/a

1 inhalation once daily

fluticasone furoate+umeclidinium+vilanterol

(Trelegy)

n/a [NB3]

100+62.5+25 micrograms once daily

200+62.5+25 micrograms once daily

single-dose DPI

(Ellipta)

100+62.5+25 micrograms

n/a

1 inhalation once daily

n/a

200+62.5+25 micrograms

n/a

n/a

1 inhalation once daily

mometasone+indacaterol+glycopyrronium

(Enerzair)

68+114+46 micrograms once daily

136+114+46 micrograms once daily

n/a

single-dose DPI

(Breezhaler)

68+114+46 micrograms

1 inhalation once daily

n/a

n/a

136+114+46 micrograms

n/a

1 inhalation once daily

n/a

Note:

n/a = not applicable

NB1: For information about delivery devices, including links to videos and patient handouts, see Inhalational drug delivery devices.

NB2: Unless a maximum daily dose is specified, the high-dose regimen is also the maximum daily dose.

NB3: At the time of writing, evidence to define a low dose of fluticasone furoate (either alone or in combination with vilanterol) is insufficient; some publications consider formulations containing 100 micrograms as low dose.

NB4: Suggested low- and medium-dose regimens of beclometasone+formoterol refer to regular maintenance doses, not as-required doses or ‘maintenance and reliever’ regimens.

NB5: The combination inhaler of beclometasone+formoterol is not available in a formulation containing a high dose of beclometasone, so is not appropriate for Step 5 therapy. The maximum daily dose of beclometasone+formoterol, including all doses taken as maintenance and reliever therapy, is 800+48 micrograms.

NB6: Suggested low- medium- and high-dose regimens of budesonide+formoterol refer to regular maintenance doses, not as-required doses or ‘maintenance and reliever’ regimens.

NB7: The maximum daily dose of budesonide+formoterol includes doses taken as reliever and maintenance therapy.

NB8: At the time of writing, the budesonide+formoterol 200+6 micrograms formulation of pMDI is not approved by the Australian Therapeutic Goods Administration (TGA) for use as ICS+formoterol 'maintenance and reliever therapy'.

NB9: The budesonide+formoterol 400+12 microgram formulation is not suitable for use as reliever therapy; to use the same device for both 'maintenance and reliever' therapy, use the 200+6 microgram formulation.

Table 2. Non–ICS inhalers available in Australia for asthma

Drug (brand examples)

Device (brand example) [NB1]

Dose per inhalation

SABA inhalers

salbutamol

(Ventolin, Asmol, Airomir)

pMDI

100 micrograms

breath-activated pMDI

(Autohaler)

100 micrograms

terbutaline

(Bricanyl)

multiple-dose DPI

(Turbuhaler)

500 micrograms

LAMA inhalers

tiotropium

(Spiriva)

mist inhaler

(Respimat)

2.5 micrograms

Note:

ICS = inhaled corticosteroid; LAMA = long-acting muscarinic agonist; SABA = short-acting beta2 agonist

NB1: For information about delivery devices, including links to videos and patient handouts, see Inhalational drug delivery devices.