Beclometasone inhalers

1. Introduction

Beclometasone inhalers, commonly marketed under brand names such as Qvar, Clenil Modulite, and Beclazone, are corticosteroid inhalers used to manage asthma and chronic obstructive pulmonary disease (COPD). They work by reducing inflammation in the airways, thus preventing and controlling symptoms like wheezing and breathlessness.

2. Indications

  • Approved Indications:
    • Maintenance treatment of asthma in adults and children.
    • Chronic obstructive pulmonary disease (COPD) with a significant inflammatory component (off-label in some cases).
  • Off-Label Uses:
    • Eosinophilic bronchitis.

3. Dosage

  • Asthma (Adults and Children >12 years):
    • Low dose: 100–200 mcg twice daily.
    • Medium dose: 200–400 mcg twice daily.
    • High dose: 400–800 mcg twice daily.
  • Children (5–12 years):
    • Low dose: 50–100 mcg twice daily.
    • Maximum dose: 200 mcg twice daily.
  • Dosage may vary based on the severity of asthma or COPD and should be individualised.

4. Administration

  • Administer via a metered-dose inhaler (MDI) or dry powder inhaler (DPI).
  • Shake the MDI well before use.
  • Use a spacer device for better delivery and reduced oropharyngeal side effects, especially in children.
  • Rinse mouth with water after use to prevent oral thrush.

5. Forms Available

  • Metered-Dose Inhaler (MDI): 50 mcg, 100 mcg, 200 mcg per actuation.
  • Dry Powder Inhaler (DPI): 100 mcg, 200 mcg per actuation.

6. Side Effects

6.1. Common Side Effects

  • Hoarseness or dysphonia.
  • Oral thrush (candidiasis).
  • Sore throat.

6.2. Less Common Side Effects

  • Cough or bronchospasm after inhalation.
  • Skin bruising.

6.3. Rare but Serious Side Effects

  • Adrenal suppression (in high doses or prolonged use).
  • Growth suppression in children (rare, with prolonged use).
  • Hypersensitivity reactions, including rash and angioedema.

7. Warnings

  • Not for use in acute asthma attacks; use a short-acting beta-agonist (e.g., salbutamol) instead.
  • Prolonged high-dose use may lead to systemic corticosteroid effects.
  • Caution in patients with untreated infections, especially fungal, viral, or bacterial infections of the respiratory tract.

8. Precautions

  • Use the lowest effective dose to control symptoms.
  • Monitor growth in paediatric patients on prolonged therapy.
  • Advise patients to adhere strictly to maintenance therapy, even in the absence of symptoms.

9. Interactions

  • Drug-Drug Interactions:
    • Ritonavir and other strong CYP3A4 inhibitors may increase systemic corticosteroid levels, leading to adrenal suppression.
  • Drug-Food Interactions:
    • No significant interactions.

10. Monitoring Parameters

  • Symptom control and frequency of exacerbations.
  • Growth in paediatric patients.
  • Signs of adrenal suppression in prolonged high-dose therapy.

11. Use in Children

  • Approved for use in children aged 5 years and above.
  • Dosage adjustments are necessary based on age and severity of asthma.
  • Use a spacer device to improve drug delivery and reduce side effects.

12. Use in Pregnancy

  • Generally considered safe in pregnancy.
  • Use the lowest effective dose.
  • Uncontrolled asthma poses a greater risk to the mother and foetus than inhaled corticosteroids.

13. Use in Elderly

  • No specific dosage adjustments required.
  • Monitor for osteoporosis and adrenal suppression with prolonged use.

14. Use in Kidney Disease

  • No dose adjustments required; primarily acts locally in the lungs with minimal systemic absorption.

15. Use in Liver Disease

  • No dose adjustments required; systemic absorption is minimal.

16. Patient Counselling Points

  • Explain the importance of regular use, even when asymptomatic.
  • Demonstrate correct inhaler technique to ensure proper drug delivery.
  • Advise rinsing the mouth with water after inhalation to prevent oral thrush.
  • Inform patients that the inhaler is not for acute symptoms; carry a reliever inhaler for emergencies.
  • Store inhalers at room temperature and check the dose counter regularly.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
QvarTeva Pharmaceuticals$45 (200 doses, 100 mcg)
Clenil ModuliteChiesi$40 (200 doses, 100 mcg)
BeclazoneNorton Healthcare$35 (200 doses, 100 mcg)
Generic OptionsVarious$25–30 (200 doses, 100 mcg)

18. FAQs (15 Questions)

  1. What is a beclometasone inhaler used for?
    It is used to prevent and control symptoms of asthma and COPD by reducing inflammation in the airways.
  2. How does a beclometasone inhaler work?
    It reduces airway inflammation by inhibiting inflammatory mediators, improving breathing over time.
  3. Can beclometasone inhalers be used during an asthma attack?
    No, they are not suitable for acute asthma attacks; use a reliever inhaler instead.
  4. What are the common side effects of beclometasone inhalers?
    Hoarseness, oral thrush, and sore throat.
  5. How can I prevent oral thrush while using a beclometasone inhaler?
    Rinse your mouth with water after each use.
  6. Can children use beclometasone inhalers?
    Yes, they are approved for children aged 5 and above with appropriate dosage adjustments.
  7. Is beclometasone safe during pregnancy?
    Yes, it is generally safe when used at the lowest effective dose.
  8. Can I stop using my beclometasone inhaler if I feel better?
    No, continue using it as prescribed to prevent symptom recurrence.
  9. How should I store my beclometasone inhaler?
    Store it at room temperature, away from heat and moisture.
  10. What should I do if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double doses.
  11. Does beclometasone interact with other medicines?
    Yes, strong CYP3A4 inhibitors like ritonavir may increase its systemic effects.
  12. How long does it take for a beclometasone inhaler to work?
    It may take several days to weeks to achieve full effects.
  13. Do I need regular check-ups while using a beclometasone inhaler?
    Yes, periodic assessments of symptom control and inhaler technique are recommended.
  14. Can beclometasone cause weight gain?
    Unlikely at standard doses, as systemic absorption is minimal.
  15. Can I use a spacer with a beclometasone inhaler?
    Yes, using a spacer improves drug delivery and reduces the risk of oral thrush.