Estimated comparative daily doses for inhaled glucocorticoids in children

Drug	Low daily dose		Medium daily dose		High daily dose
Drug	Child 0 to 4	Child 5 to 11	Child 0 to 4	Child 5 to 11	Child 0 to 4	Child 5 to 11
Beclomethasone HFA 40 or 80 mcg/puff	NA	40 mcg/puff - 1 to 2 puffs twice per day	NA	40 mcg/puff - 2 to 4 puffs twice per day 80 mcg/puff - 1 to 2 puffs twice per day	NA	80 mcg/puff - 3 to 4 puffs twice per day
Budesonide DPI* (breath activated) 90 or 180 mcg/inhalation	NA	90 mcg/inhalation - 1 to 2 inhalations twice per day	NA	180 mcg/inhalation - 1 to 2 inhalations twice per day	NA	180 mcg/inhalation - 3 to 4 inhalations twice per day
Budesonide nebulization suspension^¶ 0.25 mg/2 mL, 0.5 mg/2 mL, or 1 mg/2 mL	0.25 to 0.5 mg once daily or as 2 divided doses	0.5 mg once daily or as 2 divided doses	0.75 to 1 mg once daily or as 2 or 3 divided doses	1 mg once daily or as 2 divided doses	1.25 to 2 mg once daily or as 2 divided doses	2 mg once daily or as 2 divided doses
Ciclesonide HFA^Δ 80 or 160 mcg/puff	NA	80 mcg/puff - 1 to 2 puffs once daily	NA	80 mcg/puff - 3 to 4 puffs once daily	NA	80 mcg/puff - 5 to 6 puffs once daily or as 2 divided doses 160 mcg/puff - 3 puffs once daily or as 2 divided doses
Fluticasone HFA^◊ 44, 110, or 220 mcg/puff	44 mcg/puff - 2 puffs twice per day^◊	44 mcg/puff - 1 to 2 puffs twice per day	44 mcg/puff - 2 to 4 puffs twice per day 110 mcg/puff - 1 puff in AM and 2 puffs in PM	44 mcg/puff - 2 to 4 puffs twice per day 110 mcg/puff - 1 puff in AM and 2 puffs in PM	110 mcg/puff - 2 puffs twice per day 220 mcg/puff - 1 puff twice per day	110 mcg/puff - 2 puffs twice per day 220 mcg/puff - 1 puff twice per day
Fluticasone DPI (breath activated)^§ 50, 100, or 250 mcg/inhalation	NA	50 mcg/inhalation - 1 to 2 inhalations twice per day	NA	50 mcg/inhalation - 3 to 4 inhalations twice per day 100 mcg/inhalation - 1 inhalation in AM and 2 inhalations in PM to 2 inhalations twice per day	NA	100 mcg/inhalation - 2 inhalations in AM and 3 inhalations in PM 250 mcg/inhalation - 1 inhalation twice per day
Mometasone aerosol DPI (breath activated)* 110 or 220 mcg/inhalation	NA	110 mcg/inhalation - 1 inhalation once daily	NA	110 mcg/inhalation - 2 to 3 inhalations once daily	NA	110 mcg/inhalation - 4 inhalations once daily or 2 inhalations twice per day 220 mcg/inhalation - 2 inhalations once daily or 1 inhalation twice per day
Mometasone HFA MDI 50, 100, or 200 mcg/puff	NA	50 mcg/puff - 1 puff once or twice per day	NA	50 mcg/puff - 2 to 3 puffs twice per day 100 mcg/puff - 1 puff twice per day	NA	100 mcg/puff - 2 puffs twice per day 200 mcg/puff - 1 inhalation twice per day

Some doses may be outside approved package labeling, especially in the high-dose range. Doses shown and strengths (ie, mcg per puff or inhalation) are based upon product descriptions approved in the United States, which may differ from how strengths are described for products available in other countries. Consult local product information before use.

HFA: hydrofluoroalkane; NA: not approved and no data available for this age group; DPI: dry-powder inhaler; AM: in morning; PM: in evening; US FDA: US Food and Drug Administration; MDI: metered-dose inhaler.
* Contains milk protein.
¶ Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer. Use only jet nebulizers as ultrasonic nebulizers are ineffective for suspensions.
Δ Ciclesonide is not approved by the US FDA for use in children under 12. It is approved for use in children 6 years of age and older in Canada, some European countries, and elsewhere.
◊ For fluticasone HFA, the low dose for children <4 years is higher than for children 5 to 11 years of age due to lower dose delivered with facemask and data on efficacy in young children.
§ Contains lactose.

Data from:

National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Updated 2012. Available at www.ginasthma.org.

Graphic 68517 Version 18.0

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Estimated comparative daily doses for inhaled glucocorticoids in children