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

From: Asthma

  Usual adult dose Pediatric dose information
< 6 years of age 6–18 years of age
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
Nebules: 0.25–0.5 mg bid (for children 3 months to 12 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 Not indicated for children < 12 years
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 Not indicated for children < 18 years of age
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 Not indicated for children < 18 years
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 Not indicated for children < 18 years
 Reslizumab (Cinqair) 3 mg/kg IV every 4 weeks Not indicated for children < 18 years
 Benralizumab (Fasenra) 30 mg sc every 4 weeks for the first 3 doses, then every 8 weeks thereafter Not indicated for children < 18 years
  1. Pediatric dose information adapted from BCGuidelines.ca Guidelines & Protocols Advisory Committee, 2015 [31]
  2. ICS inhaled corticosteroid, pMDI pressurized metered-dose inhaler, DPI dry powder inhaler, LTRA leukotriene receptor antagonists, IgE immunoglobulin E, IL-5 interleukin 5, bid twice daily, sc subcutaneously, IV intravenously, LABA long acting beta agonist, LAMA long-acting muscarinic receptor antagonist, po oral, prn as needed