1.1. Adults
To manage EIB in adults, one salmeterol 50 mcg inhalation is administered at least 30 minutes before exercise on an as needed basis and should not be repeated for at least 12 hours after administration of the previous dose. Patients receiving twice daily LABA doses chronically should not administer additional LABA doses for EIB management.
Maximum recommended adult daily doses for LABA use as monotherapy in asthma and COPD are summarized in Table 1. Prescribed dosages exceeding these guidelines will be reviewed.
LABA/ICS combinations are FDA-approved for use in asthma and COPD maintenance therapy. Advair Diskus® 250 mcg/50 mcg is the only fluticasone/salmeterol dose approved for use in adult patients with COPD. Symbicort® 80 mcg/4.5 mcg and 160 mcg/4.5 mcg are FDA-approved for use in asthma, while 160 mcg/4.5 mcg is the recommended strength for budesonide/formoterol in COPD. Advair HFA®, AirDuo RespiClick®, AirDuo Digihaler®, and Dulera® are FDA-approved for asthma management only.
Maximum adult daily dosages for LABA combination therapy are summarized in Table 2. Dosages exceeding these recommendations will be reviewed.
Drug Name | Dosage Form/Strength | Treatment Indication | Maximum Recommended Dosage |
---|---|---|---|
olodaterol hydrochloride (Striverdi Respimat®) | inhalation aerosol: 2.5 mcg/actuation | COPD | 2 actuations once daily; total dose = 5 mcg/day |
salmeterol (Serevent Diskus®) | inhalation powder: 50 mcg/inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 100 mcg/day |
COPD | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 100 mcg/day |
Drug Name | Dosage Form/Strength | Treatment Indication | Maximum Recommended Dosage |
---|---|---|---|
aclidinium bromide/formoterol fumarate (Duaklir Pressair) | inhalation powder: 400 mcg/ 12 mcg/ inhalation | COPD | 2 actuations/day (1 actuation twice daily); total dose = 800 mcg/24 mcg/day |
budesonide/ formoterol ((Symbicort, generics) | inhalation aerosol: 80 mcg/4.5 mcg/ inhalation | Asthma | 4 actuations/day (2 actuations twice daily); total dose = 320 mcg/18 mcg/day |
inhalation aerosol: 160 mcg/4.5 mcg/inhalation | Asthma | 4 actuations/day (2 actuations twice daily); total dose = 640 mcg/18 mcg/day | |
COPD | 4 actuations/day (2 actuations twice daily); total dose = 640 mcg/18 mcg/day | ||
budesonide/ glycopyrrolate/ formoterol fumarate (Breztri Aerosphere) | inhalation aerosol: 160 mcg/9 mcg/4.8 mcg/inhalation | COPD | 4 actuations/day (2 actuations twice daily); total dose = 640 mcg/ 36 mcg/ 19.2 mcg/ day |
fluticasone propionate/salmeterol xinafoate (Advair HFA, generic) | inhalation aerosol: 45 mcg fluticasone/21 mcg salmeterol/inhalation | Asthma | 4 actuations/day (2 actuations twice daily); total dose = 180 mcg/84 mcg/day |
inhalation aerosol: 115 mcg fluticasone/21 mcg salmeterol/inhalation | 4 actuations/day (2 actuations twice daily); total dose = 460 mcg/84 mcg/day | ||
inhalation aerosol: 230 mcg fluticasone/21 mcg salmeterol/inhalation | 4 actuations/day (2 actuations twice daily); total dose = 920 mcg/84 mcg/day | ||
fluticasone propionate/ salmeterol (Advair Diskus, Wixela Inhub, generics) | inhalation powder: 100 mcg fluticasone/50 mcg salmeterol/ inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 200 mcg/100 mcg/day |
inhalation powder: 250 mcg fluticasone/50 mcg salmeterol/inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose =500 mcg/100 mcg/day | |
COPD | 2 actuations/day in divided doses (1 actuation twice daily); total dose =500 mcg/100 mcg/day | ||
inhalation powder: 500 mcg fluticasone/50 mcg salmeterol/inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 1000 mcg/100 mcg/day | |
fluticasone propionate/salmeterol (AirDuo RespiClick) | inhalation powder: 55 mcg fluticasone/14 mcg salmeterol/inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 110 mcg/28 mcg/day |
inhalation powder: 113 mcg fluticasone/14 mcg salmeterol/inhalation | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 226 mcg/28 mcg/day | ||
inhalation powder: 232 mcg fluticasone/14 mcg salmeterol/inhalation | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 464 mcg/28 mcg/day | ||
fluticasone propionate/salmeterol (AirDuo Digihaler) | inhalation powder: 55 mcg fluticasone/ 14 mcg salmeterol/inhalation | Asthma | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 110 mcg/28 mcg/day |
inhalation powder: 113 mcg fluticasone/14 mcg salmeterol/inhalation | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 226 mcg/28 mcg/day | ||
inhalation powder: 232 mcg fluticasone/14 mcg salmeterol/inhalation | 2 actuations/day in divided doses (1 actuation twice daily); total dose = 464 mcg/28 mcg/day | ||
fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta) | inhalation powder: 100 mcg/ 62.5 mcg/ 25 mcg/inhalation | Asthma | 1 actuation/day; total dose = 100 mcg/62.5 mcg/ 25 mcg/day |
COPD | 1 actuation/day; total dose = 100 mcg/62.5 mcg/ 25 mcg/day | ||
inhalation powder: 200 mcg/ 62.5 mcg/ 25 mcg/inhalation | Asthma | 1 actuation/day; total dose = 200 mcg/62.5 mcg/ 25 mcg/day | |
fluticasone furoate/vilanterol (Breo Ellipta, generics) | inhalation powder: 100 mcg fluticasone/25 mcg vilanterol/inhalation | Asthma | 1 actuation/day; total dose = 100 mcg/25 mcg/day |
inhalation powder: 200 mcg fluticasone/25 mcg vilanterol/inhalation | 1 actuation/day; total dose = 200 mcg/25 mcg/day | ||
inhalation powder: 100 mcg fluticasone/25 mcg vilanterol/inhalation | COPD | 1 actuation/day; total dose = 100 mcg/25 mcg/day | |
glycopyrrolate/ formoterol (Bevespi Aerosphere) | inhalation aerosol: 9 mcg glycopyrrolate/ 4.8 mcg formoterol/ actuation | COPD | 4 actuations/day in two divided doses (2 actuations twice daily); total dose = 36 mcg/19.2 mcg/day |
mometasone/ formoterol (Dulera) | inhalation aerosol: 100 mcg mometasone/5 mcg formoterol/inhalation | Asthma | for patients on medium-dose inhaled corticosteroids: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 400 mcg/20 mcg/day |
inhalation aerosol: 200 mcg mometasone/5 mcg formoterol/inhalation | patients on high-dose inhaled corticosteroids: 4 actuations/day in divided doses (2 actuations twice daily); total dose = 800 mcg/20 mcg/day | ||
tiotropium/olodaterol (Stiolto Respimat) | inhalation aerosol: 2.5 mcg tiotropium/2.5 mcg olodaterol/inhalation | COPD | 2 actuations once daily (total dose = 5 mcg/5 mcg/day |
umeclidinium/vilanterol (Anoro Ellipta) | inhalation powder: 62.5 mcg umeclidinium/25 mcg vilanterol/inhalation | COPD | 1 actuation/day; total dose = 62.5 mcg/25 mcg/day |