Usual doses of dual and triple combination inhaled glucocorticoids and LABAs +/– LAMAs for asthma in adolescents and adults

Medication	Low dose	Medium dose	High dose
ICS-LABA combinations
Budesonide-formoterol HFA (Brand name: Symbicort)*
80 mcg to 4.5 mcg	2 inhalations twice a day
160 mcg to 4.5 mcg		2 inhalations twice a day
Fluticasone furoate-vilanterol DPI (Brand name: Breo Ellipta)^¶^Δ
NOTE: Inhaled 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.
100 mcg to 25 mcg		1 inhalation once daily
200 mcg to 25 mcg			1 inhalation once daily
Fluticasone propionate-salmeterol DPI (Brand names: Advair Diskus, Wixela Inhub)^Δ
100 mcg to 50 mcg	1 inhalation twice a day
250 mcg to 50 mcg		1 inhalation twice a day
500 mcg to 50 mcg			1 inhalation twice a day
Fluticasone propionate-salmeterol HFA (Brand name: Advair HFA)
45 mcg to 21 mcg	2 inhalations twice a day
115 mcg to 21 mcg		2 inhalations twice a day
230 mcg to 21 mcg			2 inhalations twice a day
Fluticasone propionate-salmeterol DPI (Brand name: AirDuo RespiClick, AirDuo Digihaler)^Δ^◊
55 mcg to 14 mcg	1 inhalation twice a day
113 mcg to 14 mcg	1 inhalation twice a day	1 inhalation twice a day
232 mcg to 14 mcg			1 inhalation twice a day
Mometasone-formoterol HFA (Brand name: Dulera)*
100 mcg to 5 mcg		2 inhalations twice a day
200 mcg to 5 mcg			2 inhalations twice a day
Mometasone-indacaterol DPI (Brand name: Atectura Breezhaler; available in Canada)^Δ
80 mcg to 150 mcg	1 inhalation (capsule) once a day
160 mcg to 150 mcg		1 inhalation (capsule) once a day
320 mcg to 150 mcg			1 inhalation (capsule) once a day
ICS-LAMA-LABA combinations^§
Fluticasone furoate-umeclidinium-vilanterol DPI (Brand name: Trelegy Ellipta)^Δ
100 mcg to 62.5 mcg to 25 mcg		1 inhalation once daily
200 mcg to 62.5 mcg to 25 mcg			1 inhalation once daily
Mometasone-glycopyrrolate (glycopyrronium)-indacaterol DPI (Brand name: Enerzair Breezhaler; available in Canada)^¶^Δ
160 mcg to 50 mcg to 150 mcg			1 inhalation (capsule) once a day

Do not exceed the maximum number of inhalations/puffs per day listed in the table due to the risk of toxicity from an excess dose of long acting beta-agonist (ie, salmeterol, formoterol, or vilanterol). Brand names and dose per puff or per inhalation of commercially available fixed dose combinations are according to United States licensed product information. Consult local product information before use.

ICS: inhaled glucocorticoid (inhaled corticosteroid); LABA: long-acting beta agonist; LAMA: long-acting muscarinic antagonist; HFA: metered dose inhaler with hydrofluoroalkane propellant; DPI: dry powder inhaler; SMI: soft mist inhaler.

* When using budesonide-formoterol or mometasone-formoterol as reliever, use 1 to 2 puffs as needed. Maximum daily dose of maintenance and rescue is 12 puffs.

¶ Not approved for use in patients <18 years old.

Δ Contains lactose which may have small amounts of milk protein.

◊ In AirDuo inhalers, the daily dose of salmeterol is approximately one-fourth of the dose in Advair, and the daily dose of fluticasone is approximately one-half that of the comparable low, medium, and high dose strengths of Advair.

§ Alternatively, tiotropium SMI (Brand name: Spiriva Respimat) can be used with an ICS or ICS-LABA inhaler. The dose in asthma is 2 inhalations (1.25 mcg/inhalation) once daily.

Reference: Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2020; 146:1217.

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