2. Duration of Therapy
ICS, both as individual agents and as combination therapy, are FDA-approved for managing chronic asthma and COPD and may be continued indefinitely, as both COPD and asthma are chronic, lifelong processes22. Additionally, current guideline recommendations include the use of combined formoterol and budesonide as maintenance and rescue therapy for most patients with asthma, including the use of this combination as needed23. However, days’ supply per canister is limited based on the number of actuations per canister combined with the maximum recommended dose per day. Recommended days’ supply for available ICS as monotherapy or combined with long-acting beta2-agonists are summarized in Tables 5 and 6. Fluticasone is available as both the furoate and propionate salts; fluticasone propionate is available as four different formulations in three dosage strengths per formulation. Each dosage strength is associated with a maximum recommended dose (cited in Tables 1 and 3) which is used in combination with the number of actuations per drug canister to calculate days’ supply. Fluticasone/salmeterol inhalation powder formulations have also been approved for asthma management (AirDuo RespiClick and AirDuo Digihaler) with three different dosage formulations available; days’ supply can be calculated using dosages provided in Tables 2 and 4. Combined therapy with fluticasone furoate and vilanterol is available as two blister strips, with fluticasone in one strip and vilanterol in the second strip; similarly, triple therapy with fluticasone furoate, umeclidinium, and vilanterol is available as two blister strips, with fluticasone in one strip and umeclidinium and vilanterol in the second strip. Excessive use of ICS may be identified based on refill frequency. Inappropriate supply of ICS will be reviewed by monitoring refill requests.
| Drug Name | # of Actuations Per Canister | Days’ Supply (based on maximum dose per day)+ |
|---|---|---|
| beclomethasone dipropionate HFA aerosol 40 mcg/actuation (10.6 g canister) | 120 |
|
| 80 mcg/actuation (10.6 g canister) | 120 |
|
| budesonide inhalation powder 90 mcg/actuation (165 mg canister) |
60 |
|
| 180 mcg/actuation (225 mg canister) | 120 |
|
| ciclesonide inhalation aerosol 80 mcg/actuation (6.1 g canister) |
60 |
|
| 160 mcg/actuation (6.1 g canister) | 60 |
|
| fluticasone furoate dry powder inhaler 50 mcg/actuation 30 blisters |
30 | 30 |
| 100 mcg/actuation 30 blisters |
30 | 30 |
| 200 mcg/actuation 30 blisters |
30 | 30 |
| fluticasone propionate HFA aerosol 44 mcg/actuation (10.6 g canister) |
120 | 30 days (child) |
| 110 mcg/actuation (12 g canister) | 120 | 7.5 days (adults, adolescents) |
| 220 mcg/actuation (12 g canister) | 120 | 15 days (adults, adolescents) |
| fluticasone propionate dry powder inhaler 50 mcg/actuation 60 blisters |
60 | 15 days (child) |
| 100 mcg/actuation 60 blisters |
60 | 30 days (child) |
| 250 mcg/actuation 60 blisters |
60 | 7.5 days (adults, adolescents) |
| fluticasone propionate dry powder inhaler (Digihaler®) 55 mcg/actuation (0.9 g canister) |
60 | 30 days (adults, adolescents) |
| 113 mcg/actuation (0.9 g canister) | 60 | 30 days (adults, adolescents) |
| 232 mcg/actuation (0.9 g canister) | 60 | 30 days (adults, adolescents) |
| mometasone inhalation aerosol 50 mcg/actuation (13 g canister) |
120 | 30 days (child) |
| 100 mcg/actuation (13 g canister) | 120 | 30 days (adults, adolescents) |
| 200 mcg/actuation (13 g canister) | 120 | 30 days (adults, adolescents) |
| mometasone inhalation powder 110 mcg/actuation (135 mg canister) | 30 | 30 (child) BD alone, ICS: 7.5 days (adults, adolescents) OCS: 3.75 days (adults, adolescents) |
|
mometasone inhalation powder 220 mcg/actuation
|
|
|
Legend:
- + calculated based on canister size and maximum dose allowed per day (summarized in Tables 1 & 3)
- BD = bronchodilator
- ICS = inhaled corticosteroids
- OCS = oral corticosteroids
| Drug | # of Actuations Per Canister | Days’ Supply (based on maximum dose per day)+ |
|---|---|---|
| budesonide/formoterol inhalation aerosol# 80 mcg/4.5 mcg/actuation |
120 | 30 |
| 160 mcg/4.5 mcg/actuation | 120 | 30 |
| budesonide/ glycopyrrolate/ formoterol fumarate inhalation aerosol 160 mcg/9 mcg/4.8 mcg/inhalation | 120 | 30 |
| fluticasone propionate/ salmeterol xinafoate inhalation aerosol^ 45 mcg fluticasone/21 mcg salmeterol / actuation |
120 60 |
30 15 |
| 115mcg fluticasone/21 mcg salmeterol/ actuation | 120 60 |
30 15 |
| 230 mcg fluticasone/21 mcg salmeterol/ actuation | 120 60 |
30 15 |
| fluticasone propionate/salmeterol inhalation powder* 100 mcg fluticasone/50 mcg salmeterol/ actuation 60 blisters |
60 | 30 |
| 250 mcg fluticasone/50 mcg salmeterol/ actuation 60 blisters |
14 60 |
7 30 |
| 500 mcg fluticasone/50 mcg salmeterol/ actuation 60 blisters |
14 60 |
7 30 |
| fluticasone/salmeterol inhalation powder 55 mcg/14 mcg/actuation |
60 | 30 |
| 113 mcg/14 mcg/actuation | 60 | 30 |
| 232 mcg/14 mcg/actuation | 60 | 30 |
| fluticasone furoate/ umeclidinium/ vilanterol inhalation powder~ 100 mcg/62.5 mcg/25 mcg/actuation
|
30 |
30 |
200 mcg/62.5 mcg/25 mcg/actuation
|
14 30 |
14 30 |
| fluticasone furoate/vilanterol inhalation powder $ 100 mcg/25/mcg/actuation
|
14 30 |
14 30 |
200 mcg/25 mcg/actuation
|
14 30 |
14 30 |
| mometasone furoate/formoterol inhalation aerosol# 50 mcg/5 mcg/actuation |
120 | 30 |
| 100 mcg/5 mcg/actuation |
120 |
15 30 |
| 200 mcg/5 mcg/actuation |
120 |
15 30 |
Legend:
- + calculated based on canister size and maximum allowed dose per day (summarized in Tables 2 & 4)
- * Salmeterol inhalation powder, alone or in combination with fluticasone as Advair Diskus®, may be used in children greater than 4 years of age
- # Budesonide/formoterol indicated in children 6 years of age and older and mometasone/formoterol inhalation aerosols is indicated for children 5 years of age and older
- ^ Fluticasone/salmeterol inhalation aerosol only indicated for children greater than or equal to 12 years of age
- $ Fluticasone/vilanterol powder not indicated for use in children