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

Recommended Dosage and Treatment Plan for Qvar (Beclomethasone Dipropionate) in Asthma Management

For adults and adolescents with asthma, Qvar (beclomethasone dipropionate) should be started at 40-80 mcg twice daily for those previously on bronchodilators alone, or 40-160 mcg twice daily for those previously on inhaled corticosteroids, with a maximum recommended dose of 320 mcg twice daily. 1

Dosing Recommendations by Age Group

Adults and Adolescents

• Starting dose:
  • For patients previously on bronchodilators alone: 40-80 mcg twice daily 1
  • For patients previously on inhaled corticosteroids: 40-160 mcg twice daily 1
• Maximum recommended dose: 320 mcg twice daily 1

Children 5-11 years

• Starting dose:
  • For patients previously on bronchodilators alone: 40 mcg twice daily 1
  • For patients previously on inhaled corticosteroids: 40 mcg twice daily 1
• Maximum recommended dose: 80 mcg twice daily 1

Administration Guidelines

• Priming: Prime Qvar by actuating into the air twice before using for the first time or if not used for over ten days 1
• Delivery method: Administer by oral inhalation 1
• Spacer devices: Not recommended for children under 5 years of age 1
• Timing of effects:
  • Improvement in symptoms typically occurs within 1-2 weeks of starting treatment 1
  • Maximum benefit should be expected after 3-4 weeks of therapy 1
  • If inadequate response after 3-4 weeks, consider increasing the dose 1

Treatment Approach Based on Asthma Severity

Mild Persistent Asthma (Phase 2)

• Qvar 400-800 mcg daily (equivalent to beclomethasone) plus short-acting β2-agonist as needed 2
• Consider adding a long-acting β2-agonist if symptoms persist 2

Moderate Persistent Asthma (Phase 3)

• Qvar >800 mcg daily plus short-acting β2-agonist as needed 2
• Alternative approach: Qvar 400-800 mcg daily plus long-acting β2-agonist 2

Severe Persistent Asthma (Phase 4)

• Qvar >800 mcg daily plus long-acting β2-agonist 2
• May require addition of oral steroids, ipratropium 2

Special Considerations

Patients Not Previously on Systemic Corticosteroids

• Improvement in pulmonary function is usually apparent within 1-4 weeks after starting therapy 1
• Once desired effect is achieved, consider tapering to the lowest effective dose 1

Patients Maintained on Systemic Corticosteroids

• Initially use Qvar concurrently with the patient's usual maintenance dose of systemic corticosteroids 1
• After approximately one week, begin gradual withdrawal of systemic corticosteroids 1
• Reduce dose slowly, with decrements not exceeding 2.5 mg of prednisone or equivalent 1
• Monitor for symptoms of systemic corticosteroid withdrawal (joint/muscular pain, lassitude, depression) 1
• During periods of stress or severe asthma attacks, supplementary treatment with systemic corticosteroids may be required 1

Efficacy and Dose Considerations

• Qvar (HFA-BDP) provides improved lung deposition compared to older CFC-BDP formulations 3
• The smaller particle size (1.1 μm vs 3.5-4.0 μm) allows for greater deposition in the lungs, particularly in small airways 3
• Due to improved delivery, adult patients typically require approximately half the dose of Qvar compared to CFC-BDP formulations for the same degree of asthma control 3

Monitoring and Follow-up

• Titrate the dose downward over time to the lowest level that maintains proper asthma control 1
• This is particularly important in children since Qvar has the potential to affect growth 1
• For patients who respond to Qvar, consider tapering to the lowest effective dose once the desired effect is achieved 1

Common Side Effects and Precautions

• Most common side effect: oropharyngeal candidiasis (dose-related, more common in women) 4
• At recommended doses (up to 640 mcg/day), Qvar causes no more adrenal suppression than equivalent CFC-BDP formulations 3
• Rare cases of paradoxical bronchospasm have been reported, particularly in patients with alcohol-induced asthma 5

Remember that Qvar should be used as part of a comprehensive asthma management plan that includes appropriate monitoring of symptoms and lung function.