ICS Monotherapy Inhalers
ICS monotherapy inhalers include fluticasone propionate, budesonide, beclomethasone dipropionate, mometasone, ciclesonide, flunisolide, and triamcinolone—all available as single-agent formulations without long-acting beta-agonists (LABAs).
Available ICS Monotherapy Agents
The following inhaled corticosteroids are available as monotherapy (without LABA combination):
- Fluticasone propionate - Available as metered-dose inhaler (MDI) and dry powder inhaler (DPI); highly effective and safe in low-to-medium doses 1
- Budesonide - Available as DPI and nebulizer suspension; the only Pregnancy Category B ICS (all others are Category C); approved for children ≥6 months as nebulizer suspension 1
- Beclomethasone dipropionate - Available as MDI; equivalent efficacy to budesonide 1
- Mometasone - Preferred for once-daily dosing 1
- Ciclesonide - Highly effective once-daily; minimal side effects even at high doses 1
- Flunisolide - Fewer side effects but relatively less effective 1
- Triamcinolone - Generally less effective with more side effects than other ICS options 1
Clinical Context from Guidelines
Current asthma guidelines have shifted away from ICS monotherapy as the primary approach in many scenarios. The 2020 NAEPP guidelines recommend daily low-dose ICS with as-needed SABA for quick-relief in individuals aged ≥12 years with mild persistent asthma 2. However, the guidelines also conditionally recommend either this approach OR as-needed ICS and SABA used concomitantly 2.
For children aged 0-4 years with recurrent wheezing triggered by respiratory infections, short courses of daily ICS at infection onset are conditionally recommended 2.
Important Caveats
In real-world pediatric practice (ages 6-11 years), recent evidence suggests ICS monotherapy may be less effective than ICS-LABA combinations for preventing exacerbations 3, 4. Studies from 2025-2026 demonstrate significantly higher exacerbation rates with fluticasone propionate monotherapy compared to fixed-dose ICS-LABA combinations 4.
Among ICS monotherapy options, activated ICS formulations (fluticasone propionate, budesonide) appear superior to prodrug formulations (ciclesonide) for achieving asthma control in children, with prodrugs showing 2.35-fold higher odds of unsatisfactory control 5.