3.2.1 Single agent inhalers [asthma only]
|NB – inhaled steroid monotherapy is not licensed in COPD|
Beclometasone dipropionate (MDI) – Clenil Modulite®
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
For DPI preparations and doses see BNF
- 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.