Qvar RediHaler Dosing Recommendations
For adults and adolescents with persistent asthma, start Qvar RediHaler at 40-80 mcg twice daily (80-160 mcg/day total) if previously on bronchodilators alone, or 40-160 mcg twice daily (80-320 mcg/day total) if previously on inhaled corticosteroids, with a maximum dose of 320 mcg twice daily (640 mcg/day total). For children aged 5-11 years, start at 40 mcg twice daily (80 mcg/day total) regardless of previous therapy, with a maximum dose of 80 mcg twice daily (160 mcg/day total). 1
Adult and Adolescent Dosing (≥12 years)
The FDA-approved dosing strategy is straightforward and based on prior therapy 1:
Starting Doses:
- Previously on bronchodilators alone: 40-80 mcg twice daily
- Previously on inhaled corticosteroids: 40-160 mcg twice daily
Maximum Dose:
- 320 mcg twice daily (640 mcg/day total)
Key Implementation Points:
- Prime the inhaler with 2 actuations before first use or if unused for >10 days 1
- No shaking required (solution aerosol formulation) 1
- Expect symptom improvement within 1-2 weeks, but maximum benefit requires 3-4 weeks 1
- After 3-4 weeks, if inadequate response, consider increasing the dose 1
Pediatric Dosing (Ages 5-11 years)
The dosing for children is significantly lower and more restricted 1:
Starting Dose:
- 40 mcg twice daily (regardless of previous therapy)
Maximum Dose:
- 80 mcg twice daily (160 mcg/day total)
Critical Pediatric Considerations:
- Qvar has demonstrated potential to affect growth in children in controlled studies 1
- Titrate to the lowest effective dose that maintains control 1
- Not recommended with spacer devices in children <5 years 1
Dose Equivalency
The 40 mcg and 80 mcg strength products are proportional: two actuations of 40 mcg strength = one actuation of 80 mcg strength 1. This allows flexible dosing strategies.
Clinical Evidence Supporting Lower Dosing
Qvar's extrafine particle formulation (0.7 microns MMAD) achieves superior lung deposition (53-55%) compared to traditional formulations 2, which explains why it is effective at approximately half the dose of conventional CFC-BDP products 1. In clinical trials, doses as low as 40 mcg twice daily (80 mcg/day total) demonstrated significant improvement over placebo in steroid-naive adults 1.
A dose-ranging study identified 200 mcg twice daily (400 mcg/day total) as optimal for adults poorly controlled on low/medium-dose ICS 3, though the FDA label allows titration up to 640 mcg/day for severe cases 1.
Tapering Strategy
Once asthma control is achieved, titrate downward to the lowest effective dose 1. This is particularly critical in children given growth concerns. The FDA label emphasizes this approach but does not specify a tapering schedule, leaving clinical judgment to guide the rate of reduction based on individual response.
Special Population: Oral Corticosteroid-Dependent Patients
For patients maintained on systemic corticosteroids 1:
- Start Qvar concurrently with usual oral steroid dose
- After ~1 week of stability, begin gradual oral steroid withdrawal
- Reduce oral steroids by ≤2.5 mg prednisone equivalent every 1-2 weeks
- Monitor for adrenal insufficiency symptoms
- During stress or severe exacerbations, supplementary systemic steroids may be needed
Common Pitfalls to Avoid
- Do not exceed maximum doses: 640 mcg/day in adults, 160 mcg/day in children 5-11 years
- Do not use spacers in children <5 years (not studied/recommended) 1
- Do not expect immediate results: Allow 3-4 weeks for maximum benefit before dose adjustment 1
- Do not forget to prime: 2 actuations if new or unused >10 days 1