3.2.1 Single agent inhalers [asthma only]

Prescribe an inhaler with a lower carbon impact where possible – resources can be found here.

NB – inhaled steroid monotherapy is not licensed in COPD
Formulary choices

Beclometasone dipropionate (MDI) – Clenil Modulite®
50,100, 200 or 250
(micrograms/metered inhalation)

Dose: Asthma: 200 to 400 micrograms twice daily; in more severe cases 600 to 800 micrograms daily; adjusted as necessary up to 1mg twice daily

Beclometasone DPI

For DPI preparations and doses see BNF
Prescribe DPIs by brand name

Prescribing Notes

  • The device with the lowest acquisition cost should be prescribed which is consistent with the patient’s other inhaler devices and ability to use the device.
  • If prescribing a beclometasone MDI, the MHRA recommends prescribing by brand name to ensure the patient receives the correct dose and preparation. Clenil Modulite® is first choice where a MDI is required.
  • When considering doses, beclometasone dipropionate (except Qvar®) and budesonide are equipotent and fluticasone propionate is twice as potent (see BTS guidelines).
  • Spacer devices should be prescribed for patients receiving high dose steroids.
  • A corticosteroid safety card and accompanying patient information leaflets should be given to patients on high doses of inhaled steroids (more than 1000micrograms/day of beclometasone dipropionate or equivalent).
  • An additional Steroid Emergency Card for Northern Ireland has been developed in response to the National Patient Safety Alert that was issued in August 2020. The alert highlights the dangers associated with adrenal insufficiency for patients taking corticosteroid medication, and recommends that all eligible patients prescribed (or initiated on) steroids are assessed and where necessary issued with a Steroid Emergency Card. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net
  • In adults, doubling the dose of inhaled steroids at the time of an exacerbation of asthma has not been shown to be effective and is therefore not recommended.
  • The dose should be titrated to the lowest dose at which effective control of asthma is maintained.