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.

Table 5: Days’ Supply for Available Long-Acting Beta2-Adrenergic Metered Dose Inhalers (Adult and Pediatric Patients) - Monotherapy
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
Table 6: Days’ Supply for Available Long-Acting Beta2-Adrenergic Metered Dose Inhalers (Adult and Pediatric Patients) – Combination Therapy
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
30
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