What is the typical starting dose for a Fluticasone (Fluticasone) and Albuterol (Albuterol) inhaler for asthma or Chronic Obstructive Pulmonary Disease (COPD) treatment?

Fluticasone and Albuterol Inhaler Dosing for Asthma and COPD

For adults with asthma, the typical starting dose of fluticasone is 88-264 mcg/day (low dose) divided twice daily as controller therapy, while albuterol should be used at 2 puffs (200 mcg) every 4-6 hours as needed for symptom relief. 1

Dosing for Adults

Asthma

• Fluticasone (controller medication):

  • Low dose: 88-264 mcg/day divided twice daily 2
  • Medium dose: >264-440 mcg/day divided twice daily 2
  • High dose: >440 mcg/day divided twice daily 2

• Albuterol (rescue medication):

  • 2 puffs (200 mcg) every 4-6 hours as needed 1
  • Not recommended for long-term daily treatment
  • Regular use exceeding twice weekly for symptom control indicates inadequate asthma control 2

COPD

• Fluticasone/Salmeterol combination:

  • 250/50 mcg twice daily via inhaler for maintenance therapy 3
  • This combination has shown superior control of lung function compared to ipratropium bromide/albuterol in COPD patients 4

• Albuterol (rescue medication):

  • 2 puffs (180-200 mcg) every 4-6 hours as needed 3

Dosing for Children

Children 5-11 years

• Fluticasone (controller medication):

  • Low dose: 88-176 mcg/day divided twice daily 2
  • Medium dose: >176-352 mcg/day divided twice daily 2
  • High dose: >352 mcg/day divided twice daily 2

• Albuterol (rescue medication):

  • 2 puffs (200 mcg) every 4-6 hours as needed 1

Children <5 years

• Fluticasone (controller medication):

  • Starting dose: 176 mcg/day divided twice daily 2
  • Note: Children <4 years generally require delivery through a face mask 2

• Albuterol (rescue medication):

  • 1-2 puffs (100-200 mcg) every 4-6 hours as needed 1
  • For children <10 kg, always use a spacer with valve and face mask 1

Important Clinical Considerations

Monitoring and Adjustment

1. Titration principle: Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 2

2. Stepping down: When control is achieved with fluticasone/salmeterol combination, stepping down to a lower dose of the combination is more effective than switching to inhaled corticosteroid alone 5

3. Response monitoring: The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy 2

Potential Adverse Effects

1. Local side effects:

   • Cough, dysphonia, oral thrush (candidiasis)
   • Use spacer or valved holding chamber with non-breath-actuated MDIs
   • Rinse mouth and spit after inhalation to decrease local side effects 2

2. Systemic effects:

   • At high doses: adrenal suppression, osteoporosis, skin thinning, bruising
   • In low-to-medium doses: transient suppression of growth velocity in children 2
   • With albuterol: tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia 2

3. Drug interactions:

   • Fluticasone is metabolized by CYP3A4 enzymes
   • Potent inhibitors like ritonavir and ketoconazole can increase systemic concentrations 2

Special Considerations

1. COPD with carbon dioxide retention: Use air, not oxygen, to drive nebulizers 1

2. Equipment maintenance:

   • Change disposable components every 3-4 months
   • Service compressors annually
   • Have backup plan in case of equipment failure 1

By following these dosing guidelines and monitoring principles, clinicians can optimize the management of asthma and COPD while minimizing potential adverse effects.