ICS Therapeutic Substitution Chart

Therapeutic Substitution of Inhaled Corticosteroids

Dose recommendations for each brand of product are based on data from that product’s labeling. Though equivalent doses have not been established, the following dose substitution charts for HFA Metered Dose Inhalers, a Breath-activated Inhaler, and Dry Powder Inhalers can be utilized for therapeutic substitution. Suggested doses may differ from those recommended in the specific product’s labeling. For any doses outside of this range, contact provider for assistance with substitution.

Consider patient insurance coverage in determining optimal inhaler for outpatient prescribing.

Patient-specific responses to different products within these two categories of inhalers may vary. Closely monitor for dose effectiveness.

Note: Breath-activated inhalers are not compatible with valved holding chamber (spacer).

Single Maintenance and Reliever Therapy (SMART)

SMART is recommended for children ≥ 4 yrs. This method uses a single inhaled corticosteroid/long-acting beta agonist inhaler for both daily and rescue use.

Formoterol must be the long-acting beta agonist in the combination inhaler due to its rapid onset and higher maximum total daily dose.

Dose recommendations for each brand of product are based on data from that product’s labeling. Though equivalent doses have not been established, the following dose substitution charts for HFA Metered Dose Inhalers, a Breath-activated Inhaler, and Dry Powder Inhalers can be utilized for therapeutic substitution. Suggested doses may differ from those recommended in the specific product’s labeling.

Consider patient insurance coverage in determining optimal inhaler for outpatient prescribing. Patient-specific responses to different products within these two categories of inhalers may vary; closely monitor for dose effectiveness.

For any doses outside of this range, contact provider for assistance with substitution

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.