| Option 1: Inhaled corticosteroid–formoterol combination as maintenance-and-reliever therapy | |||||
| Combination and strength* | Maintenance dose† | Reliever dose | Maximum total inhalations in any single day‡ | ||
| Budesonide 200 microg + formoterol 6 microg via DPI (Symbicort Turbuhaler, Rilast Turbuhaler, DuoResp Spiromax) | 2 inhalations twice daily | 1 inhalation – can be repeated after a few minutes if symptoms persist. Maximum 6 inhalations at any one time (rarely needed) | 12 | ||
| Beclometasone 100 microg + formoterol 6 microg via pMDI (Fostair) – adults ≥18 years only | 2 inhalations twice daily | 1 inhalation via spacer – can be repeated after a few minutes if symptoms persist. Maximum 6 inhalations at any one time (rarely needed) | 8 | ||
| Budesonide 100 microg + formoterol 3 microg via pMDI (Symbicort Rapihaler, Rilast Rapihaler) | 4 inhalations twice daily | 2 inhalations (1 at a time) via spacer – can be repeated after a few minutes if symptoms persist. Maximum 12 inhalations at any one time (rarely needed) | 24 | ||
pMDI: pressurised metered-dose inhaler; DPI: dry powder inhaler; MART: maintenance-and-reliever therapy *Lower doses are available but not suitable after recent severe exacerbation. Note: ICS-formoterol cannot be used as reliever for patients receiving maintenance treatment with a combination of an inhaled corticosteroid and any long-acting beta2 agonist other than formoterol. †Short-term use after severe exacerbation ‡ Includes maintenance doses and extra doses taken for relief of symptoms. Note: very few patients need the maximum permitted number of inhalations in one day | |||||
| Option 2. Inhaled corticosteroid (alone or in combination with long-acting beta2 agonist) | |||||
Total daily dose (microg/day) | |||||
| Low | Medium | High | |||
| Not adequate after severe exacerbation | Recommended at discharge | If severe or life-threatening acute asthma | |||
| Beclometasone dipropionate | 100–200 | 250–400 | >400 | ||
| Budesonide | 200–400 | 500–800 | >800 | ||
| Ciclesonide | 80–160 | 240–320 | >320 | ||
| Fluticasone furoate (once/day only) | – | 100 | 200 | ||
| Fluticasone propionate | 100–200 | 250–500 | >500 | ||
Note: Prescribe at least medium-dose inhaled corticosteroid (in combination with a long-acting beta2 agonist) in the short term for adults and adolescents being discharged after a severe exacerbation. The patient also uses a short-acting beta2 agonist (salbutamol or terbutaline) as needed to relieve symptoms | |||||
Additional information
Suggested short-term preventive treatment for adults and adolescents after a severe asthma exacerbation, in addition to oral corticosteroids as indicated