What is the recommended dosage of inhaled corticosteroids (ICS) for mild asthma?

From the Guidelines

For mild asthma, the recommended steroid inhaler dosage is 80 to 250 μg of beclomethasone equivalent as needed, which can be administered in two to four puffs every 4 hours as needed for asthma symptoms, in addition to two to four puffs of albuterol. This approach is based on the 2020 focused updates to the asthma management guidelines, which suggest that individuals aged 12 years and older with mild persistent asthma may benefit from intermittent ICS dosing 1. The guidelines also emphasize the importance of shared decision-making between clinicians and patients to determine the best treatment approach.

When using an inhaled steroid, proper technique is essential to ensure effective delivery of the medication. This includes shaking the inhaler, exhaling fully, placing the mouthpiece between the lips, inhaling slowly while activating the inhaler, holding breath for 10 seconds, and then exhaling slowly. After use, rinsing the mouth can help prevent thrush.

Key points to consider when using steroid inhalers for mild asthma include:

• The dosage of 80 to 250 μg of beclomethasone equivalent as needed, which can be administered in two to four puffs every 4 hours as needed for asthma symptoms
• The importance of proper inhaler technique to ensure effective delivery of the medication
• The need for regular follow-up with a healthcare provider to ensure that the intermittent regimen is still appropriate
• The importance of shared decision-making between clinicians and patients to determine the best treatment approach, as the treatment options do not have different effects on asthma control, asthma quality of life, or the frequency of asthma exacerbations when studied in large groups of people 1.

From the FDA Drug Label

For patients aged 12 years and older, the dosage is 1 inhalation twice daily, approximately 12 hours apart. When choosing the starting dosage strength of Wixela Inhub®, consider the patients’ disease severity, based on their previous asthma therapy, including the ICS dosage, as well as the patients’ current control of asthma symptoms and risk of future exacerbation. The maximum recommended dosage is Wixela Inhub® 500/50 twice daily. For patients with asthma aged 4 to 11 years who are not controlled on an ICS, the dosage is 1 inhalation of Wixela Inhub® 100/50 twice daily, approximately 12 hours apart.

The recommended steroid inhaler dosage for mild asthma is:

• For adult and adolescent patients (12 years and older): 1 inhalation of Wixela Inhub® twice daily, approximately 12 hours apart, with a maximum recommended dosage of Wixela Inhub® 500/50 twice daily.
• For pediatric patients (4 to 11 years): 1 inhalation of Wixela Inhub® 100/50 twice daily, approximately 12 hours apart. 2

From the Research

Steroid Inhaler Dosage Recommendation for Mild Asthma

• The optimal dosage of steroid inhalers for mild asthma is a topic of ongoing research, with various studies investigating the efficacy of different dosages and types of inhaled corticosteroids (ICS) 3, 4, 5, 6, 7.
• A study published in 2001 found that both high and standard initial doses of budesonide were equally effective in controlling symptoms and improving lung function in mild-to-moderate asthma 3.
• Another study published in 2003 suggested that the addition of a long-acting beta2-agonist (LABA) to ICS appears more efficacious than adding a short-acting beta2-agonist or an antileukotriene, although available data are sparse 4.
• A comparison of fluticasone propionate and beclomethasone dipropionate in the treatment of severe asthma found that 1 mg/day of fluticasone propionate was as effective as 2 mg/day of beclomethasone dipropionate in controlling severe asthma 5.
• A review of combination treatment with fluticasone propionate and salmeterol found that this combination provides greater asthma control than increasing the ICS dose alone, while reducing the frequency and severity of exacerbations 6.
• A systematic review of inhaled fluticasone versus inhaled beclomethasone or inhaled budesonide for chronic asthma found that fluticasone produced a significantly greater FEV1 and morning and evening PEF when compared at a FP:BUD/BDP dose ratio of 1:2 7.

Key Findings

• The optimal dosage of steroid inhalers for mild asthma may depend on the specific type of ICS and the individual patient's response to treatment 3, 7.
• Combination treatment with ICS and LABA may provide greater asthma control than increasing the ICS dose alone 4, 6.
• Fluticasone propionate may be more effective than beclomethasone dipropionate or budesonide in controlling asthma symptoms and improving lung function, although the risk of side effects may be higher when given at the same daily dose 7.