inhaler dosage

hi im just wondering if anyone can shed any light for me. my son has had his clenil modulite inhaler increased from 2 puffs of 50 twice per day to 1 puff of 200 twice per day. this was following a serious asthma attack in march. we have seen the consultants at the hospital recently and medication is the same. but im worried that the dosage is too high for him after i went to collect his perscription from another chemist. the pharmasist told me that a 200 inhaler is far to high for his age (he is 2 years 10 months) i then read the leaflet that said it was unsuitable for children. i am now worried it could be doing him some harm. i did email the asthma uk team but unfortunatly missed their call back.

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  • Hi, firstly don't worry, the dose for children is usually started at 100micrograms dose twice daily, which was what your son was on, but a maximum of 400micrograms per day for difficult cases may be prescribed and given in two or four separate doses. If it was as usual 2 puffs twice a day of the 200, then the pharmacist would be correct, but a single puff of 200 twice daily may be easier for him and you, and is the maximum that is recomended.

    Children must however always use a spacer and I think i remember you have one with the face mask for him. Hope he gets well soon.

    Chris

  • ah thank you so much i feel a bit better. i was so worried that he has been having it for months and it may be harmful. his asthma is so much more controlled and yes i always make sure he uses the face mask. thanks again helen x( ps this is jakeys mum 4got i was on my dads page.lol)

  • Taken from the SPC for Clenil. Please remember the dosage instructions listed below are for the standard two puffs per time, but your son is only using 1 puff per time.

    4.2 Posology and method of administration

    Clenil Modulite is for inhalation use only.

    The Volumaticâ„¢ spacer device may be used by patients who have difficulty synchronising aerosol actuation with inspiration of breath.

    Posology

    The starting dose of inhaled beclometasone dipropionate should be adjusted to the severity of the disease. The dose may then be adjusted until control is achieved and then should be titrated to the lowest dose at which effective control of asthma is maintained.

    Adults (including the elderly):

    Clenil Modulite 50 micrograms, 100 micrograms & 200 micrograms:

    The usual starting dose is 200 micrograms twice daily. In severe cases this may be increased to 600 to 800 micrograms daily. This may then be reduced when the patient's asthma has stabilised. The total daily dosage should be administered as two to four divided doses.

    Clenil Modulite 250 micrograms:

    Usually 1000 micrograms daily, which may be increased to 2000 micrograms daily. This may then be reduced when the patient's asthma has stabilised. The total daily dosage should be administered as two to four divided doses.

    The Volumaticâ„¢ spacer device must always be used when Clenil Modulite is administered to adults and adolescents 16 years of age and older taking total daily doses of 1000 micrograms or greater.

    Children:

    Clenil Modulite 50 micrograms & 100 micrograms:

    The usual starting dose is 100 micrograms twice daily. Depending on the severity of asthma, the daily dose may be increased up to 400 micrograms administered in two to four divided doses.

    Clenil Modulite 200 micrograms & 250 micrograms:

    Clenil Modulite 200 micrograms & 250 micrograms are not recommended for children.

    Clenil Modulite must always be used with the Volumaticâ„¢ spacer device when administered to children and adolescents 15 years of age and under, whatever dose has been prescribed.

    Patients with hepatic or renal impairment:

    No dosage adjustment is needed in patients with hepatic or renal impairment.

    Method of Administration

    The aerosol spray is inhaled through the mouth into the lungs. The correct administration is essential for successful therapy. The patient must be instructed on how to use Clenil Modulite correctly and advised to read and follow the instructions printed on the Patient Information Leaflet carefully.

    Instructions for Use

    If the inhaler is new or has not been used for three days or more, one puff should be released into the air. It is not necessary to shake the inhaler before use because this is a solution aerosol.

    Instruct the patient to remove the mouthpiece cover and check that it is clean and free from foreign objects. The patient should then be instructed to breathe out before placing the inhaler into their mouth. They should then close their lips around the mouthpiece and breathe in steadily and deeply. They must not bite the mouthpiece. After starting to breathe in through the mouth, the top of the inhaler should be pressed down. Whilst the patient is still breathing in, the patient should then remove the inhaler from their mouth and hold their breath for about 5 to 10 seconds, or as long as is comfortable, and then breathe out slowly. The patient must not breathe out into the inhaler. If another dose is required the patient should be advised to wait 30 seconds before repeating the procedure just described. Finally, patients should breathe out slowly and replace the mouthpiece cover.

    The patient should be told not to rush the procedure described. It is important that the patient breathes in as slowly as possible prior to actuation. Inform the patient that if a mist appears on inhalation, the procedure should be repeated.

    It may be helpful to advise children and patients with weak hands to hold the inhaler with two hands, by placing both forefingers on top of the inhaler and both thumbs at the bottom of the device.

    Patients who find it difficult to co-ordinate actuation with inspiration of breath should be told to use a Volumaticâ„¢ spacer device to ensure proper administration of the product.

    Young children may find it difficult to use the inhaler properly and will require help. Using the inhaler with the Volumaticâ„¢ spacer device with a face mask may help in children under 5 years.

    Advise the patient to thoroughly rinse the mouth or gargle with water or brush the teeth immediately after using the inhaler.

    The patient should be told of the importance of cleaning the inhaler at least weekly to prevent any blockage and to carefully follow the instructions on cleaning the inhaler printed on the Patient Information Leaflet. The inhaler must not be washed or put in water.

    The patient should be told also to refer to the Patient Information Leaflet accompanying the Volumatic spacer device for the correct instructions on its use and cleaning.

  • Helen,

    I've read some of your old posts, and the serious attack happened back in march when the current 200 was issued, what happend to the dog after this, did that get better? The question that does now spring to mind is, has your sons asthma has been very well controlled for at least 6 months, if the answer is yes, then I would really like to that dose of steroid reduced. Such a high dose for long periods of time in young children isn't good, it can cause then to have a slower growth and reduced bone density, not sure what the actual time span is but you could when you see the Dr next consider asking for the clenil 100, if that doesn't control your son, you can then give him 3x1 puffs during the day or what works, upto the max dose of 400micrograms in a day.

    chris

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