Table 7 Overview of the main controller therapies used for the treatment of asthma [23, 31]

ICSs

 Beclomethasone (Qvar, generics)

pMDI: 100–800 µg/day, divided bid

pMDI

• Low 50 µg bid

• Med 100 µg bid

• High refer to specialist

Approved age by Health Canada ≥ 5 years

pMDI

• Low 50–100 µg bid

• Med > 100 µg bid

• High > 200 µg bid

 Budesonide (Pulmicort)

DPI: 400–2400 µg/day, divided bid

Nebules: 1–2 mg bid

DPI not recommended for children < 6 years

DPI

• Low 100 µg bid

• Med 200–400 µg bid

• High > 400 µg bid

Approved age by Health Canada ≥ 6 years

 Ciclesonide (Alvesco)

pMDI: 100–800 µg/day

pMDI:

• Low 100 µg once daily

• Med 200 µg daily

• High refer to specialist

pMDI:

• Low 100 µg once daily

• Med 200–400 µg daily

• High > 400 µg daily

Approved age by Health Canada ≥ 6 years

 Fluticasone propionate (Flovent HFA, Flovent Diskus)

pMDI/DPI: 100–500 µg bid

pMDI/DPI

• Low 50 µg bid

• Med 100–125 µg bid

• High refer to specialist

Approved age by Health Canada ≥ 1 year for pMDI, ≥ 4 years for Diskus (DPI)

pMDI/DPI

• Low ≤ 100 µg bid

• Med > 100–200 µg bid

• High ≥ 200 µg bid

 Mometasone (Asmanex)

DPI: 200–400 µg/day

DPI not recommended for children

<6 years

DPI

• Low ≤ 200 µg daily

• Med > 100–200 µg bid

• High > 200 µg bid

Approved age by Health Canada ≥ 12 years

 Fluticasone furoate (Arnuity Ellipta)

DPI: 100–200 µg/day

Combination ICS/LABA inhalers

 Budesonide/formoterol (Symbicort)

DPI (maintenance): 100/6 µg or 200/6 µg, 1–2 puffs od or bid; max 4 puffs/day

DPI (maintenance and reliever): 100/6 µg or 200/6 µg, 1–2 puffs bid or 2 puffs od; plus 1 puff prn for relief of symptoms (no more than 6 puffs on any single occasion); max 8 puffs/day

Refer to specialist

DPI

• Low 100/6 µg 1 dose bid

• Med 100/6 µg 2 doses bid, 200/6 µg 1–2 doses bid

• High > 200/6 µg 2 doses bid

Approved age by Health Canada    ≥ 12 years

 Fluticasone furoate/salmeterol (Advair pMDI, Advair Diskus)

pMDI: 125/25 µg or 250/25 µg, 2 puffs bid

Diskus: 100/50 µg, 250/50 µg or 500/50 µg: 1 puff bid

Refer to specialist

Approved age by Health Canada ≥ 4 years for Diskus (DPI)

DPI/pMDI

• Low 100/50 µg bid

• Med > 100–200 µg bid

• High ≥ 250/50 µg bid

Approved age by Health Canada ≥ 12 years for pMDI

 Mometasone/formoterol (Zenhale)

For patients previously treated with

    Low-dose ICS: 50/5 µg, 2 puffs bid

    Medium-dose ICS: 100/5 µg, 2 puffs bid

    High-dose ICS: 200/5 µg, 2 puffs bid

Refer to specialist

pMDI

• Low 50/5–100/5 μg 1 dose bid

• Med 100/5 μg 2 doses bid, 200/5 μg 1–2 doses bid

• High > 200/5 μg

Approved age by Health Canada ≥ 12 years

 Fluticasone furoate/vilanterol (Breo Ellipta)

DPI: 100/25 µg/day or 200/25 µg/day

LTRAs

 Montelukast (Singulair)

10 mg tablet od (taken in the evenings)

4 mg po daily

Approved age by Health Canada ≥2 years

5 mg po daily (6–14 years)

10 mg po daily (≥ 15 years)

 Zafirlukast (Accolate)

20 mg tablet bid, at least 1 h before or 2 h after meals

Refer to specialist

20 mg tablet bid, at least 1 h before or 2 h after meals

Approved age by Health Canada ≥ 12 years

LAMAs

 Tiotropium (Spiriva Respimat)

1.25 µg, 2 puffs od

Anti-IgE therapy

 Omalizumab (Xolair)

150–375 mg sc every 2–4 weeks (based on patient’s weight and pre-treatment serum IgE level)

Not indicated for children < 6 years

75–375 mg sc every 2–4 weeks (based on patient’s weight and pre-treatment serum IgE level)

Anti-IL5 therapy

 Mepolizumab (Nucala)

100 mg sc every 4 weeks

 Reslizumab (Cinqair)

3 mg/kg IV every 4 weeks

 Benralizumab (Fasenra)

30 mg sc every 4 weeks for the first 3 doses, then every 8 weeks thereafter