Table 3.
Asthma Medications (Maintenance or Controller Medications) (65)
| MEDICATION | DAILY DOSE, BY AGE | ADVERSE EFFECTS | |||
|---|---|---|---|---|---|
| 0–4 y | 5–11 y | ≥12 y | |||
| Leukotriene modifiers | |||||
| Montelukast (leukotriene receptor antagonist) | (1–5 y): 4 mg by mouth once before bedtime | ||||
| 4- or 5-mg chewable tablet | (6–14 y): 5 mg by mouth once before bedtime | ||||
| 4-mg granules or 10-mg tablet | (>14 y): 10 mg by mouth once before bedtime | ||||
| Immunomodulators | |||||
| Omalizumab (anti-IgE) SC injection, 150 mg/1.2 mL, after reconstitution with 1.4 mL of sterile saline | NA | ≥6 y: 150–375 mg SC every 2–4 wk (depends on bodyweight and pretreatment serum IgE levels) | 150–375 mg SC every 2–4 wk (depends on bodyweight and pretreatment serum IgE levels) | Pain and bruising at injection sites | |
| Risk of anaphylaxis (0.2%) | |||||
| Long-acting muscarinic antagonist | |||||
| Tiotropium bromide*2.5 μg (2 actuations; 1.25 μg/actuation) | NA | ≥6 y: 2 actuations inhaled daily | 2 Actuations inhaled daily | Caution with use if creatinine clearance <60 ml/min | |
| Inhaled corticosteroids | |||||
| Beclomethasone HFA: 40 or 80 μg/puff | NA | (L): 80–160 μg | (L): 80–240 μg | Must rinse mouth after each use to prevent oral thrush and systemic absorption | |
| (M): >160–320 μg | (M): >240–480 μg | ||||
| (H): >320 μg | (H): >480 μg | ||||
| Budesonide DPI: 90 or 180 μg/inhalation | NA | (L): 180–360 μg | (L): 180–540 μg | ||
| (M): 360–720 μg | (M): 540–1080 μg | ||||
| (H): >720 μg | (H): >1,080 μg | ||||
| Budesonide nebules: 0.25, 0.5, or 1 mg | (L): 0.25–0.5 mg | (L): 0.5 mg | NA | ||
| (M): >0.5–1 mg | (M): 1 mg | ||||
| (H): >1 mg | (H): 2 mg | ||||
| Flunisolide HFA: 80 μg/puff | NA | (L): 160 μg | (L): 320 μg | ||
| (M): 320–480 mg | (M): >320–640 μg | ||||
| (H): ≥480 μg | (H): >640 μg | ||||
| Fluticasone HFA/MDI: 44, 110, 220 μg/puff | (L): 176 μg | (L): 88–176 μg | (L): 88–264 μg | ||
| (M): >176–352 μg | (M): >176–352 μg | (M): >264–440 μg | |||
| (H): >352 μg | (H): >352 μg | (H): >440 μg | |||
| Fluticasone DPI: 50, 100, or 250 μg/inhalation | NA | (L): 100–200 μg | (L): 100–300 μg | ||
| (M): >200–400 μg | (M): >300–500 μg | ||||
| (H): >400 μg | (H): >500 μg | ||||
| Mometasone | NA | (L): 110 μg | (L): 100–220 μg | ||
| DPI: 110 μg, 220 μg/inhalation | (M):>220–440 μg | (M): >200–440 μg | |||
| HFA: 100 μg, 200 μg/puff | (H): >440 μg | (H): >440 μg | |||
| Inhaled corticosteroid + long-acting B2-agonist (combination medications) | |||||
| Fluticasone/salmeterol | NA | 1 Inhalation BID | Must rinse mouth after each use to prevent oral thrush | ||
| DPI: 100 mcg/50 μg, 250 mcg/50 μg, or 500 mcg/50 μg | Not well controlled and on low- to medium-dose ICS: 100/50 DPI or 45/21 HFA | ||||
| HFA: 45 mcg/21 μg, 115 mcg/21 μg, 230 mcg/21 μg | Not well controlled and on medium- to high-dose ICS: 250/50 DPI or 115/21 HFA | ||||
| Budesonide/formoterol HFA MDI: 80 mcg/4.5 μg, 160 mcg/4.5 μg | NA | Not well controlled and on low- to medium-dose ICS: 80/4.5 | |||
| Not well controlled and on medium- to high-dose ICS: 160/4.5 | |||||
| Mometasone/formoterol MDI: 100 μg/5 mcg | NA | NA | 2 Inhalations BID (depends on asthma severity) | ||
Doses are per National Asthma Education and Prevention Program update in September 2012 except for (*). Source: National Heart, Lung, and Blood Institute; National Institutes of Health; US Department of Health and Human Services. BID=twice a day, DPI=dry powder inhaler, (H)=high daily dose, HFA=hydrofluoroalkane, ICS=inhaled corticosteroid, IgE=immunoglobulin E, (L)=low daily dose, (M)=medium daily dose, MDI=metered-dose inhaler, NA=not available (not approved, no data available, or safety and efficacy not established in this age group), SC=subcutaneous.