United Kingdom. Beclometasone (beclomethasone dipropionate) is now available in a CFC-free inhaler (Qvar) for the prophylactic management of mild, moderate or severe asthma in adults. This new formulation containing HFA-134a as the propellant results in smaller particles of beclometasone and greater lung deposition compared with inhalers using CFCs. Studies have shown that the increased lung delivery results in a 2 to 2.5-fold greater potency of Qvar compared with the old formulation. Since the use of high-dose inhaled corticosteroids has been associated with systemic adverse effects, it is important that patients being switched from the CFC-containing inhaler to Qvar are commenced on the appropriate equivalent dose.

The conversion can be done using the following table:

Total daily dose (micrograms/day)

If patients using budesonide inhalers are to be transferred to Qvar, the same instructions should be applied. If transferring patients using fluticasone inhalers, the same total daily dose, up to a maximum of 800 micrograms/day should be substituted.

Once patients are transferred to Qvar, the dose should be adjusted to meet the needs of the individual patient, bearing in mind that, to avoid systemic adverse effects, the minimum dose should be used at which asthma control is maintained.

In patients not previously treated with an inhaled corticosteroid, Qvar may be started at doses of between 100 micrograms/day and 800 micrograms/day in two divided doses according to the severity of the asthma.

Patients should be instructed in the proper use of their inhaler, including rinsing out their mouth with water after use. They should also be advised that Qvar may have a different taste and feel than a CFC inhaler.

Reference: Current Problems in Pharmacovigilance Vol. 25, March 1999.