The American Thoracic Society (ATS) developed criteria for the diagnosis of refractory asthma. One criterion involves the use of a high dose of an inhaled corticosteroid. The dose varies between the corticosteroids depending on the relative potency of each agent.
Inhaled corticosteroids:
(1) beclomethasone dipropionate
(2) buclesonide
(3) flunisolide
(4) fluticasone proprionate
(5) triamcinolone acetonide
Measurement of daily dose:
(1) micrograms per day
(2) puffs per day (may be canister dependent)
Inhaled Corticosteroid
Threshold in micrograms per day
beclomethasone dipropionate
1,260
buclesonide
1,200
flunisolide
2,000
fluticasone proprionate
880
triamcinolone acetonide
2,000
Inhaled Corticosteroid
dose per puff
Threshold in puffs per day
beclomethasone dipropionate
42 micrograms
40
beclomethasone dipropionate
84 micrograms
20
buclesonide
6
flunisolide
8
fluticasone proprionate
110 micrograms
8
fluticasone proprionate
220 microgram
4
triamcinolone acetonide
20
A problem may arise if the patient used more than one inhaled corticosteroid. This can be handled by:
(1) converting the dose based on relative potency of each corticosteroid (see Chapter 45)
(2) calculate the percent of daily dose given above for each corticosteroid, then summate.
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