Equivalent Inhaled Corticosteroid Doses to Beclomethasone Dipropionate
Beclomethasone dipropionate (QVAR) 400 μg/day is equivalent to 800 μg/day of budesonide DPI, and roughly twice as potent as older CFC-based beclomethasone formulations. 1
Inhaled Corticosteroid Equivalence Table
| Inhaled Corticosteroid | Equivalent Daily Dose (μg) |
|---|---|
| Beclomethasone dipropionate (QVAR) | 400 |
| Budesonide DPI (Pulmicort) | 800 |
| Fluticasone propionate (Flovent/Flixotide) | 200-250 |
| Mometasone (Asmanex) | 200-220 |
| Ciclesonide (Alvesco) | 160-320 |
| Triamcinolone acetonide (Azmacort) | 1000-2000 |
| Flunisolide (Aerospan) | 1000 |
Formulation Differences and Clinical Implications
- HFA vs CFC Formulations: Modern HFA-propelled beclomethasone (QVAR) is approximately twice as potent as older CFC-based formulations due to improved lung deposition 1, 2
- Extrafine Particle Size: QVAR delivers smaller particle sizes that penetrate deeper into the airways, allowing for equivalent efficacy at lower doses 3
- Comparative Efficacy: Studies show that fluticasone propionate provides greater asthma control at roughly half the dose of older beclomethasone dipropionate formulations 2
Dosing Considerations
- Starting Doses: For mild-moderate persistent asthma, 400 μg/day of beclomethasone dipropionate is often an appropriate starting dose 1
- Step-Down Approach: Once control is achieved, consider stepping down to 200 μg/day or 100 μg/day while monitoring symptoms 3
- Rescue Use: Some evidence suggests beclomethasone can be used as rescue medication with albuterol in mild persistent asthma to reduce exacerbations while avoiding daily use 4
Potential Adverse Effects
- Local Effects: Oropharyngeal candidiasis is more common with beclomethasone dipropionate than with some other inhaled corticosteroids like triamcinolone acetonide 5
- Growth Effects: High-dose inhaled corticosteroids may affect linear growth in children (approximately 1 cm less growth over one year with daily use) 4
- Systemic Effects: At recommended doses (400-800 μg/day), beclomethasone dipropionate has minimal effects on adrenal function 6
Clinical Pearls
- When switching between inhaled corticosteroids, use the equivalence table to maintain appropriate anti-inflammatory effects
- Consider device characteristics and patient technique when selecting an inhaled corticosteroid
- Monitor for local side effects (thrush, dysphonia) which may be more common with beclomethasone compared to some other inhaled corticosteroids
- For patients with severe or refractory asthma, higher doses (>1,260 μg/day) may be required 5
- Spacer devices can reduce oropharyngeal deposition and local side effects while improving lung delivery
Remember that individual patient response to different inhaled corticosteroids may vary, and clinical response should be monitored when switching between medications.