Recommended Dosage and Treatment Regimen for Qvar (Beclomethasone) in Asthma Management
The recommended starting dose of Qvar (beclomethasone dipropionate) for adults and adolescents with asthma is 40-80 mcg twice daily, with a maximum recommended dose of 320 mcg twice daily, while children aged 5-11 years should start with 40 mcg twice daily with a maximum of 80 mcg twice daily. 1
Dosing Recommendations by Age and Previous Therapy
Adults and Adolescents:
Previously on bronchodilators alone:
- Starting dose: 40-80 mcg twice daily
- Maximum dose: 320 mcg twice daily
Previously on inhaled corticosteroids:
- Starting dose: 40-160 mcg twice daily
- Maximum dose: 320 mcg twice daily
Children (5-11 years):
Previously on bronchodilators alone:
- Starting dose: 40 mcg twice daily
- Maximum dose: 80 mcg twice daily
Previously on inhaled corticosteroids:
- Starting dose: 40 mcg twice daily
- Maximum dose: 80 mcg twice daily
Administration Guidelines
- Prime Qvar by actuating into the air twice before first use or if not used for over ten days
- Administer by oral inhalation
- No shaking required (Qvar is a solution aerosol)
- Use of spacer devices with Qvar is not recommended for children under 5 years 1
Expected Response Timeline
- Initial improvement in asthma symptoms should be expected within 1-2 weeks of starting treatment
- Maximum benefit may take 3-4 weeks of therapy
- For patients not responding adequately to the starting dose after 3-4 weeks, higher doses may provide additional control 1
Dose Adjustment and Maintenance
- Physicians should titrate the dose downward over time to the lowest level that maintains proper asthma control
- This is particularly important in children due to potential growth effects 1
- Once control is achieved, the frequency of dosing may be reduced 2
Special Considerations
Patients Not Previously on Corticosteroids
- Improvement in pulmonary function is usually apparent within 1-4 weeks after starting therapy
- Once desired effect is achieved, taper to lowest effective dose 1
Patients Maintained on Systemic Corticosteroids
- Qvar may allow replacement or significant reduction in systemic corticosteroid dosage
- Initially, use Qvar concurrently with the usual maintenance dose of systemic corticosteroids
- After approximately one week, begin gradual withdrawal of systemic corticosteroids
- Reduce dose slowly (decrements should not exceed 2.5 mg of prednisone or equivalent)
- Monitor for symptoms of systemic corticosteroid withdrawal (joint/muscular pain, lassitude, depression)
- During stress or severe asthma attacks, supplementary treatment with systemic corticosteroids may be required 1
Monitoring and Follow-up
- Regular assessment of asthma control is essential
- Patients should not be discharged from care until symptoms have stabilized or returned to normal function
- Peak expiratory flow should be above 75% of predicted value 3
- Follow-up with primary care within 1 week and respiratory specialist within 4 weeks 3
Common Pitfalls to Avoid
- Underestimating asthma severity
- Inadequate corticosteroid dosing during acute attacks
- Failure to monitor response to treatment
- Discharging patients too early without adequate follow-up plans
- Not addressing adherence issues or incorrect inhaler technique 3
Remember that Qvar is intended for maintenance therapy and not for treatment of acute asthma attacks. During acute exacerbations, short-acting bronchodilators and possibly systemic corticosteroids should be used according to established guidelines.