2. Duration of Therapy
Generally, LABAs should only be used as maintenance therapy. Recent guideline updates recommend the combined use of formoterol and budesonide as maintenance and rescue therapy for most patients with asthma, including the use of this combination as needed12.
For maintenance therapy, daily administration of LABAs alone or in combination with ICS is warranted in asthma and COPD. Formoterol combination products, olodaterol monotherapy and combination products, salmeterol monotherapy and combination products, and vilanterol combination products are metered-dose inhalers designed to deliver a set number of inhalations based on the canister size as well as the medication prescribed. Tables 5 and 6 summarize the number of inhalations available LABA and LABA combination products provide, respectively, and the days’ supply per inhaler or blister package based on the maximum dose allowed per day (see Tables 1 through 4). Excessive use may be identified based on refill frequency. Inappropriate supply of salmeterol metered-dose inhalers, salmeterol/fluticasone blister packages, formoterol blister packages, budesonide/formoterol metered-dose inhalers, or mometasone/formoterol metered-dose inhalers will be monitored by reviewing excessive refills.
Drug | # of Actuations Per Canister | Days’ Supply (based on maximum dose per day) + |
---|---|---|
salmeterol dry powder inhaler * 60 blisters |
60 | 30 |
olodaterol inhalation aerosol ~ | 60 | 30 |
Legend:
- + calculated based on canister size/blister package size and maximum dose allowed per day
- * Salmeterol inhalation powder, alone or in combination with fluticasone, may be used in children less than 4 years of age
Drug | # of Actuations Per Canister | Days’ Supply (based on maximum dose per day) + |
---|---|---|
aclidinium bromide/ formoterol fumarate inhalation 400 mcg/12 mcg/inhalation |
60 | 30 |
budesonide/formoterol inhalation aerosol # 80 mcg/4.5 mcg/inhalation |
120 | 30 |
160 mcg/4.5 mcg/inhalation | 120 | 30 |
budesonide/ glycopyrrolate/ formoterol fumarate 160 mcg/9 mcg/4.8 mcg/inhalation | 120 | 30 |
fluticasone propionate/salmeterol xinafoate inhalation aerosol ^ 45 mcg fluticasone/21 mcg salmeterol/ inhalation |
60 120 |
15 30 |
115 mcg fluticasone/21 mcg salmeterol/inhalation | 60 120 |
15 30 |
230 mcg fluticasone/21 mcg salmeterol/inhalation | 60 120 |
15 30 |
fluticasone propionate/salmeterol inhalation powder * 100 mcg fluticasone/50 mcg salmeterol/ inhalation: 60 blisters |
60 | 30 |
250 mcg fluticasone/50 mcg salmeterol/inhalation: 60 blisters |
60 | 30 |
500 mcg fluticasone/50 mcg salmeterol/inhalation: 60 blisters |
60 | 30 |
fluticasone/salmeterol inhalation powder ^ 55 mcg/14 mcg/actuation (0.45 g canister) |
60 | 30 |
113 mcg/14 mcg/actuation (0.45 g canister) | 60 | 30 |
232 mcg/14 mcg/actuation (0.45 g canister) | 60 | 30 |
fluticasone furoate/ umeclidinium/vilanterol inhalation powder ~ 100 mcg/62.5 mcg/25 mcg/actuation (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) 60 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) |
14 30 |
14 |
200 mcg/62.5 mcg/25 mcg/actuation (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) 60 blisters (one strip contains fluticasone, one strip contains umeclidinium and vilanterol) |
14 30 |
14 30 |
fluticasone furoate/vilanterol inhalation powder ~ 100 mcg/25 mcg/actuation (one strip contains fluticasone, one strip contains vilanterol) 60 blisters (one strip contains fluticasone, one strip contains vilanterol) |
14 30 |
14 30 |
200 mcg/25 mcg/actuation (one strip contains fluticasone, one strip contains vilanterol) 60 blisters (one strip contains fluticasone, one strip contains vilanterol) |
14 30 |
14 30 |
glycopyrrolate/formoterol inhalation aerosol ~ 9 mcg/4.8 mcg/actuation |
120 | 7 30 |
mometasone furoate/formoterol inhalation aerosol ^ 50 mcg/5 mcg/inhalation! |
120 | 30 |
100 mcg/5 mcg/inhalation | 120 | 15 30 |
200 mcg/5 mcg/inhalation | 120 | 15 30 |
tiotropium/ olodaterol inhalation aerosol ~ 2.5 mcg/ 2.5 mcg/inhalation |
60 | 30 5 |
umeclidinium/vilanterol inhalation powder ~ 14 blisters (one strip contains umeclidinium, one strip contains vilanterol) 60 blisters (one strip contains umeclidinium, one strip contains vilanterol) |
30 | 7 30 |
Legend:
- + calculated based on canister size/blister package size and maximum dose allowed per day
- ~ not indicated for use in children
- * Salmeterol inhalation powder, alone or in combination with fluticasone, may be used in children > 4 years of age
- # Budesonide/formoterol indicated for children > 6 years of age
- ^ Fluticasone/salmeterol inhalation aerosol and fluticasone/salmeterol inhalation powder as AirDuo® RespiClick and AirDuo Digihaler® as well as mometasone/formoterol inhalation aerosols only indicated for children > 12 years of age
- ! Mometasone furoate/ formoterol 50 mcg/ 5mcg/ inhalation is approved for children 5 years of age and older