What is the moderate dosing of Flovent (fluticasone) for a 5-year-old child with asthma?

Moderate Dose Flovent for a 5-Year-Old with Asthma

For a 5-year-old child with asthma, moderate-dose Flovent (fluticasone propionate) is >176-352 mcg per day when using the HFA/MDI formulation, or >200-500 mcg per day when using the dry powder inhaler (DPI) formulation. 1

Specific Dosing by Formulation

Fluticasone HFA/MDI (44,110,220 mcg/puff)

• Moderate dose range: >176-352 mcg per day 1
• This translates to approximately 2-4 puffs of the 110 mcg strength twice daily, or 1-2 puffs of the 220 mcg strength twice daily
• The dose should be divided and administered twice daily 2

Fluticasone DPI (50,100,250 mcg/inhalation)

• Moderate dose range: >200-500 mcg per day 1
• This can be achieved with 1 inhalation of 100 mcg twice daily (200 mcg total) up to 2-3 inhalations of 100 mcg twice daily (400-600 mcg total)
• Studies demonstrate that children as young as 4 years can effectively use the Diskus DPI device 3, 4

Important Clinical Context

Low vs. Moderate Dose Distinction:

• Low-dose fluticasone for ages 5-11 years is 88-176 mcg/day (HFA/MDI) or 200-300 mcg/day (DPI) 1
• The moderate dose begins just above these thresholds
• High-dose begins at >352 mcg/day (HFA/MDI) or >400 mcg/day (DPI) 1

Administration Recommendations

Delivery technique is critical for this age group:

• Use a spacer or valved holding chamber with MDI formulations to enhance lung deposition and reduce local side effects 1, 2
• Have the child rinse mouth and spit after each use to prevent oral thrush 1, 2
• Most 5-year-olds can use either MDI with spacer or DPI effectively, though individual assessment of technique is essential 3, 4

Safety Monitoring

At moderate doses, monitor for:

• Growth velocity, as transient growth suppression may occur but is generally small (approximately 1 cm) and non-progressive 1
• Local effects including cough, dysphonia, and oral candidiasis 1, 2
• Systemic effects are uncommon at moderate doses but increase with higher doses and prolonged use 1

Clinical Decision-Making

When to use moderate-dose therapy:

• The stepwise approach recommends moderate-dose ICS (or low-dose ICS plus LABA) for Step 3 care when low-dose ICS alone does not achieve adequate control 1, 2
• Titrate to the minimum dose that maintains asthma control, reassessing every 2-6 weeks initially 1
• If no clear benefit is observed within 4-6 weeks, consider alternative diagnoses or adjunctive therapies 1

Common pitfall: Preparations are not interchangeable on a mcg-per-puff basis between different formulations or delivery devices 1. Always verify the specific product strength and adjust dosing accordingly.