omalizumab |
Xolair |
75mg/0.5mL, 150mg/mL; 150mg/vial |
<6yrs: Not established. ≥6yrs: Base dose and frequency on baseline serum total IgE level and body weight. Give by SC inj over 5–10secs. 75–375mg every 2 or 4wks; max 150mg per inj site. |
Trial duration: ≥4mos
Eligibility: sensitization to inhaled allergen, AND total serum IgE and body weight within local range, AND more than a specified number of exacerbations within the last year
Predictors of (+) response: blood eosinophils ≥260/μL or FeNO ≥20ppb, allergen-driven symptoms, childhood-onset asthma |
Anti-IL5/5R |
mepolizumab |
Nucala |
100mg/mL, 100mg/vial |
<6yrs: Not established. 6–11yrs(use vials only): 40mg SC once every 4wks. ≥12yrs: 100mg SC once every 4wks. |
Trial duration: ≥4mos
Eligibility: more than a specified number of severe exacerbations within the last year, AND blood eosinophils ≥300/μL
Predictors of (+) response: higher blood eosinophils, higher number of severe exacerbations in previous year, adult-onset asthma, nasal polyposis, maintenance OCS at baseline |
benralizumab |
Fasenra |
30mg/mL |
<12yrs: Not established. ≥12yrs: 30mg SC once every 4wks for the first 3 doses, then once every 8wks thereafter. |
reslizumab |
Cinqair |
100mg/10mL |
<18yrs: Not established. ≥18yrs: Give by IV infusion over 20–50mins. 3mg/kg once every 4wks. |
Anti-IL4R |
dupilumab |
Dupixent |
200mg/1.14mL, 300mg/2mL |
<12yrs: Not established. ≥12yrs: Initially 400mg (two 200mg inj at different sites) SC followed by 200mg every other week; or, initially 600mg (two 300mg inj at different sites) followed by 300mg every other week. For those with oral corticosteroids-dependent asthma or with co-morbid moderate-to-severe atopic dermatitis for which Dupixent is indicated: initially 600mg followed by 300mg every other week. |
Trial duration: ≥4mos
Eligibility: more than a specified number of severe exacerbations within the last year, AND blood eosinophils ≥300/μL or FeNO ≥25ppb, OR requirement for maintenance OCS
Predictors of (+) response: higher blood eosinophils, higher FeNO |
Inhaled Corticosteroids + Long-Acting Beta2-Antagonist |
budesonide/ formoterol |
Symbicort |
80mcg/4.5mcg, 160mcg/4.5mcg |
<6yrs: Not established. 6–<12yrs: 2 inh of 80/4.5 twice daily (approx. 12hrs apart). ≥12yrs: Initially 2 inh of 80/4.5 or 160/4.5 twice daily (approx. 12hrs apart), based on asthma severity. If inadequate response after 1–2wks using 80/4.5 strength, may switch to 160/4.5 strength. Max 2 inh of 160/4.5 twice daily. |
Prime by shaking (5 secs) and spraying inhaler 2 times. Discard 3mos after opening foil pouch. |
fluticasone furoate/ vilanterol |
Breo Ellipta |
100mcg/25mcg, 200mcg/25mcg |
≤17yrs: Not established. ≥18yrs: Initially 1 inh of 100/25mcg or 200/25mcg once daily, based on disease severity and previous asthma therapy. Max 1 inh of 200/25mcg once daily. |
Discard 6wks after opening foil tray. |
fluticasone propionate/ salmeterol |
Advair HFA |
45mcg/21mcg, 115mcg/21mcg, 230mcg/21mcg |
<12yrs: Not established. ≥12yrs: Initially 2 inh of 45/21 or 115/21 or 230/21 twice daily (approx. 12hrs apart), based on disease severity and previous asthma therapy. If inadequate response after 2wks, use next higher strength. Max 2 inh of 230/21 twice daily. |
Prime by shaking (5 secs) and spraying inhaler
4 times. |
Advair Diskus |
100mcg/50mcg, 250mcg/50mcg, 500mcg/50mcg |
<4yrs: Not established. 4–11yrs: 1 inh of 100/50 twice daily (approx. 12hrs apart). ≥12yrs: Initially 1 inh of 100/50 or 250/50 or 500/50 twice daily (approx. 12hrs apart), based on disease severity and previous asthma therapy. If inadequate response after 2wks, use next higher strength. Max 1 inh of 500/50 twice daily. |
Discard 1 month after opening foil pouch. |
mometasone furoate/ formoterol |
Dulera |
50mcg/5mcg, 100mcg/5mcg, 200mcg/5mcg |
<5yrs: Not established. 5–<12yrs: 2 inh of 50mcg/5mcg twice daily (AM & PM); max 200mcg/20mcg daily.≥12yrs: Initially 2 inh of 100mcg/5mcg or 200mcg/5mcg twice daily (AM & PM), based on disease severity and previous asthma therapy. If inadequate response after 2wks, may increase dose. Max 2 inh of 200mcg/5mcg twice daily (800mcg/20mcg per day). |
Prime by shaking and spraying inhaler 4 times. |
Leukotriene Receptor Antagonist/Leukotriene Modifier |
montelukast |
Singulair |
4mg, 5mg chew tabs |
<12mos: Not established. 12–23mos: 4mg granule packet once daily in PM. 2–5yrs: 4mg chew tab or granule packet once daily in PM. 6–14yrs: 5mg chew tab once daily in PM. ≥15yrs: 10mg tab once daily in PM. |
Take granules by mouth within 15mins of opening packet; may dissolve in 5mL of cold or room temperature baby formula or breast milk, or mix in spoonful of soft applesauce, carrots, rice,
or ice cream. |
4mg granules |
10mg tabs |
zafirlukast |
Accolate |
10mg, 20mg |
<5yrs: Not established. 5–11yrs: 10 mg twice daily. ≥12yrs: 20mg twice daily. |
Take 1hr before or 2hrs after meals. |
zileuton |
Zyflo |
600mg |
<12yrs: Not recommended. ≥12yrs: 600mg four times daily; max 2400mg/day. CR: 1200mg twice daily; max 2400mg/day. |
Take with meals and at bedtime. CR: take within 1hr after AM and PM meals; swallow whole. |
Zyflo CR |
Long-Acting Anticholinergic |
tiotropium |
Spiriva Respimat |
1.25mcg/ actuation |
<6yrs: Not established. ≥6yrs: 2 inh of Spiriva Respimat 1.25mcg/actuation (2.5mcg) once daily; max 2 inh/24hrs. |
Prime by inserting cartridge into inhaler and actuating until aerosol cloud is visible; repeat 3 more times. Discard 3mos after first use. |
Short-Acting Beta2-Agonist |
albuterol |
ProAir Digihaler |
90mcg/inh |
<4yrs: Not established. ≥4yrs: 2 inh every 4–6hrs as needed; 1 inh every 4hrs may suffice in some patients |
Does not require priming. Do not use with a spacer or volume holding chamber. Discard 13mos after opening foil pouch. |
ProAir HFA |
Prime by shaking and spraying inhaler 3 times. |
ProAir Respiclick |
Does not require priming. Do not use with a spacer or volume holding chamber. Discard 13mos after opening foil pouch. |
Proventil HFA |
Prime by shaking and spraying inhaler 4 times. |
Ventolin HFA |
Prime by shaking and spraying inhaler 4 times. Discard 12mos after opening foil pouch. |
NOTES |
REFERENCE |