What is the typical dose of Foracort (Budesonide and Formoterol) for asthma and Chronic Obstructive Pulmonary Disease (COPD) management?

Foracort Dosing for Asthma and COPD

For asthma, start with budesonide/formoterol 200-400 mcg/12 mcg daily (divided into two doses of 100-200 mcg/6 mcg twice daily), and for COPD, use budesonide/formoterol 320/9 mcg twice daily (160/4.5 mcg x 2 inhalations). 1, 2

Asthma Dosing

Mild-to-Moderate Persistent Asthma

• Initial dose: 200-400 mcg budesonide with formoterol 12 mcg daily (administered as 100-200 mcg/6 mcg twice daily) 1
• This corresponds to the low-dose inhaled corticosteroid range recommended for mild persistent asthma (phase 2 treatment) 1
• The combination should be introduced early in persistent asthma, as long-acting beta-agonists combined with low-dose inhaled corticosteroids reduce exacerbations by 40% for mild exacerbations and 29% for severe exacerbations 1

Moderate-to-Severe Persistent Asthma

• Dose range: 400-800 mcg budesonide with formoterol 24 mcg daily (administered as 200-400 mcg/12 mcg twice daily) 1
• Studies demonstrate that 600 mcg budesonide twice daily for the first 24 months, then reduced to 200 mcg twice daily, maintains efficacy 1
• Higher doses of inhaled corticosteroids (800 mcg daily) combined with long-acting beta-agonists result in fewer exacerbations compared to lower doses 1

Severe Persistent Asthma

• Dose: >800 mcg budesonide with long-acting beta-agonist daily, potentially requiring oral corticosteroids 1
• This represents phase 4 treatment in the stepped approach 1

COPD Dosing

Moderate-to-Severe COPD

• Standard dose: budesonide/formoterol 320/9 mcg twice daily (delivered as 160/4.5 mcg x 2 inhalations) 2
• This dosage demonstrated significantly greater improvements in pre-dose FEV1 versus formoterol alone (p=0.026) and 1-hour post-dose FEV1 versus budesonide alone (p<0.001) 2
• The 320/9 mcg dose reduced severe exacerbations by 24% versus placebo and 23% versus formoterol alone over 12 months 3

Alternative COPD Dosing

• Lower dose option: budesonide/formoterol 160/9 mcg twice daily (delivered as 80/4.5 mcg x 2 inhalations) 2
• This lower dose significantly improved 1-hour post-dose FEV1 versus budesonide alone (p<0.001) but did not reach significance versus formoterol for pre-dose FEV1 2
• Both dosages improved dyspnea scores and health-related quality of life significantly versus monocomponents and placebo (p≤0.044) 2

Critical Dosing Principles

Never Use as Monotherapy

• Formoterol must always be combined with an inhaled corticosteroid - never use long-acting beta-agonists alone for asthma due to increased risk of severe exacerbations and deaths 4
• Patients must have persistent asthma symptoms despite inhaled corticosteroid treatment before adding a long-acting beta-agonist 4

Dose Titration Strategy

• Titrate to the minimum effective dose after achieving control, typically after the first 4 weeks of treatment 4, 5
• For asthma, adjustable maintenance dosing allows reduction from initial doses while maintaining control 6, 7
• Average daily doses in long-term studies decreased from 454 mcg budesonide twice daily at start to 374 mcg twice daily after 2 years 1

Administration Technique

• Use a large-volume spacer or dry-powder system for high doses (≥1,000 mcg/day) to improve delivery and reduce side effects 1
• Rinse mouth after each use to reduce risk of oral candidiasis and dysphonia 4, 5
• For patients unable to use inhalers properly, consider nebulizer solutions 5

Common Pitfalls to Avoid

Inadequate Initial Dosing

• Starting with doses below 200 mcg budesonide daily in persistent asthma may fail to achieve adequate control 1
• For COPD, doses below 320/9 mcg twice daily may not provide optimal exacerbation reduction 2, 3

Premature Dose Reduction

• Wait at least 4 weeks before reducing doses after achieving control 4
• In studies, maintaining higher doses (600 mcg twice daily) for 24 months before reduction to 200 mcg twice daily showed sustained benefit 1

Ignoring Disease Severity

• The dose must match disease severity: mild persistent asthma requires 200-400 mcg daily, moderate requires 400-800 mcg daily, and severe requires >800 mcg daily 1
• COPD typically requires higher doses (320/9 mcg twice daily) than mild asthma 2, 3

Monitoring Failures

• Check inhaler technique, symptom relief, and FEV1 at regular reviews 1
• For high-dose inhaled corticosteroids (≥1,000 mcg/day), monitor for osteoporosis risk and consider calcium, vitamin D, or bisphosphonates if using concurrent oral corticosteroids 1
• In children, monitor growth velocity as suppression has been observed with inhaled corticosteroid use 5