3.2.1 Single agent inhalers [asthma only]

ChoiceDrugDosage
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.
  • 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).
  • 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.