For children 12 years of age and older:
Two inhalations inhaled orally twice daily (morning and evening).
Each inhalation contains either 100 mcg or 200 mcg of mometasone with 5 mcg of formoterol.
Maximum Daily Dose: 800 mcg of mometasone; 20 mcg of formoterol
-The starting dose should be determined based on patient's previous asthma therapy.
-Patients previously on inhaled medium dose corticosteroids should be started on the 100 mcg/5 mcg strength.
-Patients previously on inhaled high dose corticosteroids should be started on the 200 mcg/5 mcg strength.
-Not for use in treatment of acute bronchospasm.
Use: Indicated for patients 12 years of age and older who have inadequate control on a long-term asthma control medication or whose disease severity requires initiation of an inhaled corticosteroid and long-acting beta2-adrenergic agonist
The ATROVENT HFA Inhalation Aerosol canister is to be used only with the accompanying ATROVENT HFA Inhalation Aerosol mouthpiece. This mouthpiece should not be used with other aerosol medications. Similarly, the canister should not be used with other mouthpieces. Each actuation of ATROVENT HFA Inhalation Aerosol delivers 21 mcg of ipratropium bromide from the valve and 17 mcg from the mouthpiece. Each gram canister provides sufficient medication for 200 actuations. The canister should be discarded after the labeled number of actuations has been used. The amount of medication in each actuation cannot be assured after this point, even though the canister is not completely empty.
This confusing situation happens often, even when the
rescue and maintenance inhalers are of
different color. The root problem is lack of standardization
among inhalers, with unclear labeling to distinguish between
rescue and maintenance inhalers. A contributing cause is
lack of proper education for both the caregivers and their patients .
All too often proper instructions were not given
when the drug was first prescribed. And even when they are provided,
patients sometimes don't really understand, or they forget.
Either way, having similar inhalers for different purposes
is an invitation to error. (This was less likely to be a problem
when the drug was studied
by the drug companies; see YELLOW BOX above, under 'DPI Type 2'.)
The problem is compounded when patients are on multiple
inhalers, eg, Proventil for rescue, Advair and Spiriva for
maintenance. That's 3 separate devices with two different
purposes -- easy for the patient to get confused. (Pills and
capsules come in many colors and sizes, but they are all
swallowed the same way.) What's needed is a universal delivery
device for all inhalers, with perhaps just two colors:
red for rescue drugs and green for maintenance drugs.
Anyone with clinical interest in the inhaler problems discussed above
(Errors 1 & 2) should definitely read
Problems With Inhaler Use: A Call for Improved Clinician and Patient Education ,
by James B. Fink and Bruck K. Rubin (Respiratory Care, Sept 2005, Vol 50, No. 10,
3. Not checking some objective measurement of the patient's air flow obstruction.
Every patient should have a breathing test to ascertain the degree of
impairment caused by the asthma. The most frequently performed
test is 'spirometry', which takes just a few minutes and requires the
patient to exhale forcefully thru a testing device (shown below).
A patient performing the spirometry test
Graphs from a normal spirometry test; left panel, graph of flow vs. volume; right panel, graph of time vs. volume.