What is the recommended dose of Qvar (beclomethasone dipropionate) for an 11-year-old female weighing 92 pounds with asthma?

Recommended Dosage of Qvar for an 11-Year-Old Female Weighing 92 Pounds with Asthma

For an 11-year-old female weighing 92 pounds (approximately 42 kg) with asthma, the recommended starting dose of Qvar (beclomethasone dipropionate) is 40-80 mcg twice daily (80-160 mcg/day), which falls within the low dose range for this age group. 1

Dosing Guidelines Based on Age and Severity

Qvar dosing for children aged 4-11 years follows these general parameters:

• Low dose: 88-176 mcg/day
• Medium dose: 176-352 mcg/day
• High dose: >352 mcg/day 1

The appropriate dose should be determined by the severity of the child's asthma:

1. Mild persistent asthma: Start with low-dose inhaled corticosteroid (88-176 mcg/day)
2. Moderate persistent asthma: Medium-dose inhaled corticosteroid (176-352 mcg/day)
3. Severe persistent asthma: High-dose inhaled corticosteroid (>352 mcg/day) plus additional controller medications 1

Administration Technique

For optimal medication delivery in this 11-year-old patient:

• Use a spacer or valved holding chamber with the Qvar inhaler 1
• Ensure proper inhalation technique: slow, deep breath (3-5 seconds) followed by a 10-second breath hold 1
• Rinse mouth after administration to prevent oral thrush 1
• Actuate only once into the spacer per inhalation 1

Monitoring and Follow-up

• Evaluate response to therapy in 4-6 weeks 1
• Monitor height regularly, as inhaled corticosteroids may have a small effect on growth velocity (approximately 1 cm) 1
• Consider stepping down therapy once control is achieved and maintained for 3 months 1

Clinical Efficacy

Clinical trials have shown that Qvar is effective at improving asthma control at doses as low as 40 mcg twice daily (80 mcg/day) in patients not adequately controlled with beta-agonists alone 2. The HFA formulation in Qvar allows for improved lung deposition compared to older CFC-based formulations, which may contribute to its efficacy at lower doses 3.

Important Considerations

1. Delivery system: Qvar's extrafine particle formulation (1.1 μm vs 3.5-4.0 μm in older formulations) allows for better lung deposition, particularly in the small airways 3

2. Dose equivalence: Qvar typically requires approximately half the dose of older CFC-beclomethasone formulations to achieve the same degree of asthma control 3

3. Age-related deposition: Studies have shown that lung deposition of Qvar increases with age in children, with 11-14 year-olds showing deposition patterns similar to adults 4

4. Side effects: The most common side effect is oropharyngeal candidiasis, which appears to be dose-related. Using a spacer and rinsing the mouth after administration can help reduce this risk 5

Cautions

• If the patient experiences an acute exacerbation of asthma while on maintenance therapy with Qvar, additional therapy including systemic corticosteroids should be used immediately 5
• Some patients may experience temporary dyspnea after Qvar inhalation, particularly those with alcohol-induced asthma, due to the ethanol content in the formulation 6

By following these guidelines, the appropriate dose of Qvar for this 11-year-old female patient can be determined based on her asthma severity, with careful monitoring for both efficacy and potential side effects.