What is the recommended dosage and management plan for Qvar Redihaler (beclomethasone dipropionate) in patients with asthma?

QVAR Redihaler Dosage and Management for Asthma Patients

QVAR Redihaler (beclomethasone dipropionate) should be dosed based on age and previous therapy, with adults starting at 40-160 mcg twice daily (up to 320 mcg twice daily maximum) and children 5-11 years starting at 40 mcg twice daily (up to 80 mcg twice daily maximum). 1

Dosing Recommendations

Adults and Adolescents

• Previous therapy: Bronchodilators alone

  • Starting dose: 40-80 mcg twice daily
  • Maximum dose: 320 mcg twice daily

• Previous therapy: Inhaled corticosteroids

  • Starting dose: 40-160 mcg twice daily
  • Maximum dose: 320 mcg twice daily

Children (5-11 years)

• Previous therapy: Bronchodilators alone

  • Starting dose: 40 mcg twice daily
  • Maximum dose: 80 mcg twice daily

• Previous therapy: 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 route
• No need to shake before use (solution aerosol)
• Not recommended for use with a spacer device in children under 5 years 1

Clinical Response Timeline

• Initial symptom improvement: 1-2 weeks
• Maximum benefit: 3-4 weeks
• If inadequate response after 3-4 weeks, consider dose increase within recommended ranges 1

Special Considerations

Patients Not on Systemic Corticosteroids

• Start at recommended doses based on previous therapy
• Improvement in pulmonary function typically appears within 1-4 weeks
• Once desired effect achieved, taper to lowest effective dose 1

Patients on Systemic Corticosteroids

• Begin QVAR concurrently with current systemic corticosteroid dose
• After approximately one week, begin gradual withdrawal of systemic corticosteroids
• Reduce systemic dose slowly (decrements should not exceed 2.5 mg prednisone equivalent)
• Monitor for symptoms of systemic corticosteroid withdrawal (joint/muscle pain, fatigue, depression)
• Watch for signs of adrenal insufficiency during withdrawal
• Supplementary systemic corticosteroids may be needed during stress or severe asthma attacks 1

Monitoring and Follow-up

• Assess asthma control at regular intervals (every 2-6 weeks initially, then every 1-6 months)
• Step up therapy according to stepwise approach if control is not achieved 2
• Use validated questionnaires like Asthma Control Test (ACT) to assess symptoms (score ≥20 indicates well-controlled asthma) 2
• Ensure proper inhaler technique at each visit
• Monitor growth in pediatric patients as QVAR may affect growth 1

Important Considerations

• QVAR is not for treatment of acute asthma attacks
• Due to its extrafine aerosol (1.1 μm particle size vs. 3.5-4.0 μm with CFC-BDP), QVAR achieves greater lung deposition, particularly in small airways 3
• Patients typically require approximately half the dose of QVAR compared to CFC-BDP formulations for equivalent asthma control 3
• Common side effect: oropharyngeal candidiasis (more common in women, appears dose-related) 4
• Rare cases of paradoxical bronchospasm have been reported, particularly in patients with alcohol-induced asthma 5

By following these dosing guidelines and monitoring protocols, QVAR Redihaler can effectively manage asthma symptoms while minimizing potential side effects.