QVAR Redihaler (Beclomethasone Dipropionate) Usage
QVAR Redihaler is primarily indicated for the maintenance treatment of asthma as prophylactic therapy in patients 5 years of age and older. 1
Primary Indications
QVAR Redihaler (beclomethasone dipropionate) is an inhaled corticosteroid (ICS) with the following approved uses:
- Maintenance treatment of asthma as prophylactic therapy in patients ≥5 years old
- For asthma patients requiring systemic corticosteroids, where adding QVAR may reduce or eliminate the need for systemic steroids 1
Mechanism of Action
QVAR works by:
- Reducing airway hyperresponsiveness
- Inhibiting inflammatory cell migration and activation
- Blocking late-phase reactions to allergens 2
Formulation Advantages
QVAR Redihaler contains HFA-beclomethasone dipropionate in solution rather than suspension, which produces an extrafine aerosol with smaller particle size (1.1 μm vs 3.5-4.0 μm with older CFC formulations). This results in:
- Greater lung deposition, particularly in small airways (a major site of inflammation)
- Equivalent asthma control at approximately half the dose compared to older CFC-BDP formulations 3
Clinical Applications
For Initial Asthma Control
- QVAR is appropriate for patients with persistent asthma requiring daily controller medication
- It is one of the most consistently effective long-term control medications at all steps of asthma care 2
For Steroid-Dependent Patients
- Can allow worthwhile reduction in maintenance doses of systemic corticosteroids
- May completely replace systemic steroids in some patients, particularly when initial prednisone dose is <10mg daily 4
For Step-Down Therapy
- After high-dose inhaled corticosteroid treatment, stepping down to QVAR at appropriate doses can maintain asthma control 5
Important Limitations
- NOT indicated for relief of acute bronchospasm 1
- Substitution from systemic steroids should be performed slowly and carefully
- Special care is necessary for 9-12 months after transfer from systemic steroids until the hypothalamo-pituitary-adrenal axis has sufficiently recovered 4
Dosing Considerations
- For adults with persistent asthma inadequately controlled on other therapies, 400 μg/day of QVAR provides equivalent control to 800 μg/day of budesonide DPI 6
- For non-specific cough in children with asthma risk factors, guidelines suggest a short (2-4 weeks) trial of 400 mg/day of beclomethasone equivalent 7
Common Side Effects
- Oropharyngeal candidiasis (dose-related, more common in women)
- At recommended doses (≤640 μg/day), minimal adrenal suppression compared to equivalent doses of older formulations 3
Clinical Pearls
- QVAR alone (without spacer devices) has shown significant improvements in FEV1 in patients with bronchial asthma 8
- When stepping down from high-dose inhaled corticosteroids, QVAR at medium doses can maintain improvements in bronchial hyperresponsiveness 5
- For children with non-specific cough and asthma risk factors, a 2-4 week trial of QVAR may be warranted, with re-evaluation after this period 7