Usual doses of combination inhaled corticosteroids (ICS) and long-acting beta agonists (LABA) for COPD

Name	Dose (adults)	Maximum dose
Available in the United States
Budesonide-formoterol MDI (brand name [United States]: Symbicort)	2 inhalations twice daily (160/4.5 mcg/actuation)	2 inhalations twice daily
Fluticasone propionate-salmeterol MDI (brand names [United States]: Advair HFA)*^¶^Δ	2 inhalations twice daily (115/21 mcg/actuation)	2 inhalations twice daily
Fluticasone propionate-salmeterol DPI (brand names [United States]: Advair Diskus, Wixela Inhub)^¶^◊	1 inhalation twice daily (250/50 mcg/actuation) (500/50 mcg/actuation)^Δ^§	1 inhalation twice daily
Fluticasone furoate-vilanterol DPI (brand name [United States]: Breo Ellipta)^◊^¥	1 inhalation once daily (100/25 mcg/actuation)	1 inhalation once daily
Mometasone-formoterol MDI (brand name [United States]: Dulera)^Δ	2 inhalations twice daily (100/5 mcg/actuation) (200/5 mcg/actuation)^§	2 inhalations twice daily
Not available in the United States but are widely available elsewhere
Beclometasone-formoterol MDI and DPI (brand name [UK and Europe]: Fostair [MDI] and Fostair Nexthaler [DPI])	2 inhalations twice daily (100/6 mcg/actuation)	2 inhalations twice daily
Budesonide-formoterol DPI (brand name [Canada]: Symbicort 200 Turbuhaler)^◊	2 inhalations twice daily (200/6 mcg/actuation)	2 inhalations twice daily
Budesonide-formoterol DPI (brand name [Canada]: Symbicort Forte Turbuhaler)^◊	1 inhalation twice daily (400/12 mcg/actuation)	1 inhalation twice daily
Fluticasone propionate-salmeterol MDI (brand name [Canada]: Advair)^¶Δ	2 inhalations twice daily (Canada: 125/25 mcg/actuation)	2 inhalations twice daily
Fluticasone propionate-salmeterol DPI (brand names [Canada]: Advair Diskus, Wixela Inhub)^¶^◊	1 inhalation twice daily (250/50 mcg/actuation) (500/50 mcg/actuation)^§	1 inhalation twice daily
Fluticasone furoate-vilanterol DPI (brand name [Canada]: Breo Ellipta)^◊^¥	1 inhalation once daily (100/25 mcg/actuation)	1 inhalation once daily
Mometasone-formoterol MDI (brand name [Canada]: Zenhale)^Δ	2 inhalations twice daily (100/5 mcg/actuation) (200/5 mcg/actuation)^§	2 inhalations twice daily

Recommended doses and strengths (ie, mcg/actuation) are for products within country or area listed; strengths and doses may be different for similar ingredient products available elsewhere. Consult local product information before use.

MDI: metered dose inhaler; HFA: metered dose inhaler with hydrofluoroalkane propellant; DPI: dry powder inhaler; ICS: inhaled corticosteroid; LABA: long-acting beta agonist.
* Fluticasone propionate-salmeterol (AirDuo RespiClick) contains a lower dose of salmeterol per inhalation and is used in asthma, but not COPD.
¶ Generic equivalent available in United States, Canada, and some other countries.
Δ ICS-LABA agent off-label for COPD.
◊ DPIs contain lactose and may contain small amounts of milk protein.
§ Additional benefit from this higher ICS dose relative to standard dose is uncertain; risk of pneumonia and systemic adverse effects may be increased. For patients with persistent symptoms and frequent exacerbations despite standard dose ICS-LABA, UpToDate authors suggest changing to triple therapy with LAMA-LABA-ICS rather than increasing the ICS component. Refer to UpToDate topic for discussion of follow-up pharmacologic management for stable COPD.
¥ Fluticasone furoate has a greater anti-inflammatory potency per microgram than fluticasone propionate inhalers. Thus, fluticasone furoate is administered at a lower daily dose and used only once daily.

Approved product labeling with additional information from Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report. Global Initiative for Chronic Obstructive Lung Disease website. https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf.

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