Generic Name: Beclomethasone Dipropionate
VA Class: NT200
Molecular Formula: C28H37ClO7
CAS Number: 5534-09-8
Uses for QVAR
Chronic Obstructive Pulmonary Disease
Efficacy in patients with chronic obstructive pulmonary disease (e.g., bronchitis)† who are stabilized with oral corticosteroids33 34 37 117 or whose disease is corticosteroid responsive117 118 remains to be fully evaluated.
Inflammatory Conditions of the GI Tract
Has been used as an oral solution35 or rectal suspension36 (these dosage forms not commercially available in the US) in the management of inflammatory diseases of the GI tract† (e.g., inflammatory bowel disease†, eosinophilic gastroenteritis†).35 36 However, the role of beclomethasone dipropionate in the management of inflammatory conditions of the GI tract remains to be established.35 36
QVAR Dosage and Administration
After a satisfactory response is obtained, decrease dosage gradually to the lowest dosage that maintains an adequate clinical response.149 150 Achieve the lowest effective dosage, particularly in children, since inhaled corticosteroids have the potential to affect growth.149 150 (See Pediatric Use under Cautions.)
Conversion to Orally Inhaled Therapy in Patients Receiving Systemic Corticosteroids
Initially, administer the aerosol concurrently with the maintenance dosage of the systemic corticosteroid.1 2 112 113 144 149 After about 1 week, gradually withdraw the systemic corticosteroid.1 2 112 113 144 149
Administer by oral inhalation using an oral aerosol inhaler.149
Oral inhalation aerosol is formulated as a solution, which does not require shaking.149
Exhale slowly and completely and place the mouthpiece of the inhaler well into the mouth with the lips closed firmly around it; keep the tongue below the mouthpiece.b Inhale slowly and deeply through the mouth while actuating the inhaler.b Hold the breath for as long as possible (about 5–10 seconds), withdraw the mouthpiece, and exhale gently.b If additional inhalations are required, repeat the procedure.b
Oral inhalation aerosol releases 50 or 100 mcg of beclomethasone dipropionate, and delivers 40 or 80 mcg, respectively, from the actuator (mouthpiece) per metered spray.149
Children 5–11 years of age receiving bronchodilators alone or inhaled corticosteroids previously: Initially, 40 mcg twice daily.149 If required, dosage may be increased to a maximum 80 mcg twice daily.149
Children ≥12 years of age receiving inhaled corticosteroids previously: Initially, 40–160 mcg twice daily. If required, dosage may be increased to a maximum 320 mcg twice daily.
Adults receiving inhaled corticosteroids: Initially, 40–160 mcg twice daily. If required, dosage may be increased to a maximum of 320 mcg twice daily.
Children 5–11 years of age: Maximum 80 mcg twice daily.149
Children ≥12 years of age: Maximum 320 mcg twice daily.149
Maximum 320 mcg twice daily.149
Consider initial dosages at the lower end of the usual range due to possible age-related decrease in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.149
Cautions for QVAR
Withdrawal Of Systemic Corticosteroid Therapy
Possible corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression);1 2 112 113 144 149 acute adrenal insufficiency;1 2 112 113 144 life-threatening exacerbation of asthma;1 2 112 113 144 149 pulmonary infiltrates with eosinophilia;1 112 113 or symptomatic exacerbation of allergic conditions1 2 27 44 52 58 70 112 113 144 if prolonged systemic corticosteroid therapy is replaced with oral inhalation corticosteroid therapy.1 2 112 113 144 149 Such symptoms may be observed especially in patients maintained on ≥20 mg of prednisone (or its equivalent) daily and particularly during the later part of the transfer.149
In general, the greater the dosage and duration of systemic corticosteroid therapy, the greater the time required for withdrawal of systemic corticosteroids and replacement by orally inhaled corticosteroids.73
Taper the dosage of the systemic corticosteroid, and carefully monitor patients during dosage reduction for objective signs of adrenal insufficiency (e.g., hypotension, weight loss).1 2 112 113 144 149
Increased susceptibility to infections in patients who are taking immunosuppressant drugs compared with healthy individuals.113 134 135 136 137 138 139 140 141 142 143 144 Certain infections (e.g., varicella [chickenpox], measles) can have a more serious or even fatal outcome in such patients, particularly in children.113 134 135 136 137 138 139 140 141 142 143 144
Exposure to varicella and measles should be avoided in previously unexposed patients.b If exposure to varicella (chickenpox) or measles occurs in susceptible patients, consider administering varicella zoster immune globulin (VZIG) or immune globulin (IG), respectively.b Consider treatment with an antiviral agent if varicella develops.b
Use with caution in patients receiving systemic prednisone for any disease.45 47 Concomitant use with prednisone in an alternate-day or daily dosing regimen could increase the likelihood of HPA-axis suppression compared with therapeutic dosages of either drug alone.45 47
Resume systemic corticosteroids during periods of stress (e.g., infection, trauma, surgery) or a severe asthma exacerbation in patients who were attempting a switch from systemic to orally inhaled corticosteroid therapy.149
Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression
Avoid higher than recommended dosages of the drug, since suppression of HPA function may occur.149 If higher than recommended dosages are used, carefully consider the relative risks of adrenal suppression and potential therapeutic benefits.149 Recommended dosages of orally inhaled drug provide less than normal physiologic amounts of glucocorticoid systemically and do not provide mineralocorticoid activity.149 Orally inhaled drug will not compensate for insufficient endogenous cortisol production caused by previous systemic corticosteroid therapy.149
If bronchospasm occurs, treat immediately with a short-acting bronchodilator, and discontinue treatment with beclomethasone dipropionate and institute alternative therapy.149
Use with caution, if at all, in patients with clinical tuberculosis or latent M. tuberculosis infection of the respiratory tract; untreated systemic fungal, bacterial, or parasitic infections; or ocular herpes simplex or untreated, systemic viral infections.1 2 100 144 149
Systemic Corticosteroid Effects
Possible signs and symptoms of Cushing’s syndrome (e.g., hypertension, glucose intolerance, cushingoid features) in patients who are particularly sensitive to corticosteroid effects or when usual dosages of the drug are exceeded.100 149
Glaucoma, increased intraocular pressure, and cataracts reported rarely.149
Unknown long-term, systemic, and local effects of the drug in humans, particularly developmental or immunologic processes in the mouth, pharynx, trachea, and lung.149
Category C.149 (See Systemic Corticosteroid Effects under Cautions.)
Safety and efficacy not established in children <5 years of age.149 No overall differences in the pattern, severity, or frequency of adverse events in children 5–12 years of age compared with those in adults.149 Monitor periodically children receiving prolonged therapy for possible adverse effects on growth and development.62 149
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.149
Use caution due to the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy in geriatric patients.149 (See Geriatric Patients under Dosage and Administration.)
Common Adverse Effects
Headache, pharyngitis, upper respiratory tract infection, rhinitis.149
Interactions for QVAR
Metabolized by CYP3A4.149
Drugs Affecting Hepatic Microsomal Enzymes
Inhibitors of CYP3A4: potential pharmacokinetic interaction (increased plasma beclomethasone dipropionate concentrations).a
Inducers of CYP3A4: potential pharmacokinetic interaction (decreased plasma beclomethasone dipropionate concentrations).a
May increase blood glucose concentrations in patients with diabetes mellitus
Adjust insulin and/or oral hypoglycemic dosages as needed
Possible increased risk of GI ulcerationa
Use salicylates and corticosteroids concurrently with cautiona
Observe patients receiving both drugs closely for adverse effects of either druga
May be necessary to increase salicylate dosage when corticosteroids are administered concurrently or decrease salicylate dosage when corticosteroids are discontinueda
Vaccines and Toxoids
May cause a diminished response to toxoids and live or inactivated vaccinesa
May potentiate replication of some organisms contained in live, attenuated vaccinesa
Can aggravate neurologic reactions to some vaccines (supraphysiologic dosages) a
Generally defer routine administration of vaccines or toxoids until corticosteroid therapy is discontinueda
May need serologic testing to ensure adequate antibody response for immunizationa
Additional doses of the vaccine or toxoid may be necessarya
May undertake immunization procedures in patients receiving nonimmunosuppressive doses of glucocorticoids or in patients receiving glucocorticoids as replacement therapy (e.g., Addison’s disease)a
Absorbed into circulation following oral inhalation, 149 with peak plasma concentrations usually attained at 0.5 hour.149 After oral inhalation, 51–60% of the dose is deposited in the respiratory tract.154
Relief of respiratory symptoms usually is evident within 24 hours; however, about 1–4 weeks of continuous therapy may be required for optimum effectiveness.149
Metabolized to active metabolites via CYP3A4.149
Beclomethasone dipropionate and its metabolites eliminated principally in feces and to a lesser extent in the urine (<10%).149
25°C (may be exposed to 15–30°C).149
Principal sites of action are the bronchi and bronchioles.149
May reduce the following: number of mediator cells (basophils, leukocytes, and mast cells) at the epithelial level, number of eosinophils, sensitivity of sensory nerves to mechanical stimuli, secretory response to cholinergic receptor stimulation, and fibroblast activity.c
May inhibit capillary dilation and permeability, stabilize lysosomal membranes, and prevent subsequent release of proteolytic enzymes.c
Advice to Patients
Importance of providing the patient a copy of the manufacturer's patient information.149
Importance of understanding that although improvement may occur within the first 24 hours, at least 1–4 weeks of continuous therapy may be required for optimal effectiveness.1 2 61 77 100 112 113 144 149
Advise patients being transferred from systemic corticosteroid to beclomethasone dipropionate oral inhalation therapy to carry special identification (e.g., card, bracelet) indicating the need for supplementary systemic corticosteroids during periods of stress.1 2 112 113 144 149 (See Concomitant Therapy under Cautions.)
Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.149
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.149
Importance of advising patients of other important precautionary information.149 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
40 mcg/metered spray
QVAR Oral Inhaler (with tetrafluoroethane propellants)
80 mcg/metered spray
QVAR Oral Inhaler (with tetrafluoroethane propellants)
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2015. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Qvar 40MCG/ACT Aerosol (IVAX PHARMACEUTICALS): 9/$115.99 or 26/$326.97
Qvar 80MCG/ACT Aerosol (IVAX PHARMACEUTICALS): 9/$146.98 or 26/$414.95
AHFS DI Essentials. © Copyright, 2004-2015, Selected Revisions February 15, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
1. Schering Corporation. Vanceril 42 mcg (beclomethasone dipropionate, 42 mcg) inhalation aerosol prescribing information. Kenilworth, NJ; 2000 Aug.
2. Glaxo Wellcome. Beclovent (beclomethasone dipropionate) inhalation aerosol prescribing information. Research Triangle Park, NC; 1997 Dec.
3. Schering Corporation. Vanceril basic data book. Kenilworth, NJ; 1976 May.
4. Harris DM. Clinical pharmacology of beclomethasone dipropionate. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:34-47.
5. Wade A, ed. Martindale: the extra pharmacopeia. 27th ed. London: The Pharmaceutical Press; 1977:401-2.
6. Bondarevsky E, Shapiro MS, Schey G et al. Beclomethasone dipropionate use in chronic asthmatic patients: effect on adrenal function after substitution for oral glucocorticoids. JAMA. 1976; 236:1969-71. [IDIS 64768] [PubMed 989561]
7. Smith AP, Booth M, Davey AJ. A controlled trial of beclomethasone dipropionate for asthma. Br J Dis Chest. 1973; 67:208-14. [PubMed 4580987]
8. Harvey LL, Nair SV, Kass I. Beclomethasone dipropionate aerosol in the treatment of steroid-dependent asthma. Chest. 1976; 70:345-50. [IDIS 77953] [PubMed 782796]
9. Pines A. Beclomethasone dipropionate used as an aerosol in the treatment of asthma. Practitioner. 1975; 211:86-90.
10. Cayton RM, Soutar CA, Stanford CF et al. Double-blind trial comparing two dosage schedules of beclomethasone dipropionate aerosol in the treatment of chronic bronchial asthma. Lancet. 1974; 2:303-7. [PubMed 4136046]
11. Brown HM, Storey G. Beclomethasone dipropionate steroid aerosol in the treatment of perennial allergic asthma in children. Br Med J. 1973; 3:161-4. [IDIS 37188] [PubMed 4352726]
12. Dickson W, Hall CE, Ellis M et al. Beclomethasone dipropionate aerosol in childhood asthma. Arch Dis Child. 1973; 48:671-5. [IDIS 47206] [PubMed 4354778]
13. Gwynn CM, Smith JM. A one year follow-up of children and adolescents receiving regular beclomethasone dipropionate. Clin Allergy. 1974; 4:325-30.
14. Kerrebijn KF. Beclomethasone dipropionate in long-term treatment of asthma in children. J Pediatr. 1976; 89:821-6. [IDIS 79822] [PubMed 789844]
15. Vogt F, Chervinsky P, Dwek J et al. Beclomethasone dipropionate aerosol in the treatment of chronic bronchial asthma. J Allergy Clin Immunol. 1976; 58:316-21. [IDIS 75020] [PubMed 780407]
16. Choovoravech P, Preeyasombat C. Trial of beclomethasone dipropionate aerosol in the treatment of severe chronic asthma. Practitioner. 1978; 220:639-42. [IDIS 99093] [PubMed 349536]
17. Klein R, Waldman D, Kershnar H et al. Treatment of chronic childhood asthma with beclomethasone dipropionate aerosol. Part I: a double-blind crossover trial in nonsteroid-dependent patients. Pediatrics. 1977; 60:7-13. [IDIS 89666] [PubMed 327424]
18. Mackay JB. The impact of beclomethasone dipropionate aerosol on patients with reversible airways obstruction attending a chest clinic. Postgrad Med J. 1975; 51(Suppl 4):37-41. [PubMed 812073]
19. Zwi S, Van As A, Goldman HI et al. The measurement of response to beclomethasone dipropionate treatment for asthma. Postgrad Med J. 1975; 51(Suppl 4):64-7. [PubMed 1105521]
20. Johannessen H, Halvorsen FJ, Kommedal TM. Long-term treatment of patients with perennial bronchial asthma with beclomethasone dipropionate aerosol: a 24 month follow-up study. Curr Ther Res. 1979; 26:592-600.
21. Vandenberg R, Tovey E, Love I et al. Beclomethasone dipropionate: trial of a new inhalational steroid preparation in the treatment of steroid-dependent chronic asthmatics. Med J Aust. 1975; 1:189-93. [IDIS 51266] [PubMed 1128399]
22. Webb DR. Corticosteroid aerosols in the treatment of asthma. Bull Mason Clin. 1975; 29:98-106.
23. Brown HM, Storey G, George WHS. Beclomethasone dipropionate: a new steroid aerosol for the treatment of allergic asthma. Br Med J. 1972; 1:585-90. [IDIS 24974] [PubMed 4335298]
24. Bacal E, Patterson R. Long-term effects of beclomethasone dipropionate on prednisone dosage in the corticosteroid asthmatic. J Allergy Clin Immunol. 1978; 62:72-5. [IDIS 115339] [PubMed 670607]
25. Richards W, Platzker A, Church JA et al. Steroid-dependent asthma treated with inhaled beclomethasone dipropionate in children. Ann Allergy. 1978; 41:274-7. [IDIS 118451] [PubMed 362991]
26. Toogood JH, Lefcoe NM, Haines DSM et al. Minimum dose requirements of steroid-dependent asthmatic patients for aerosol beclomethasone and oral prednisone. J Allergy Clin Immunol. 1978; 61:355-64. [IDIS 98988] [PubMed 659727]
27. Kershnar H, Klein R, Waldman D et al. Treatment of chronic childhood asthma with beclomethasone dipropionate aerosols. Part II: effect on pituitary-adrenal function after substitution for oral corticosteroids. Pediatrics. 1978; 62:189-97. [IDIS 115288] [PubMed 358120]
28. Anon. Beclomethasone dipropionate (Vanceril) for asthma. Med Lett Drugs Ther. 1976; 18:76. [PubMed 958155]
29. Anon. Steroid aerosols for asthma. Med Lett Drugs Ther. 1975; 17:88. [PubMed 1186604]
30. Ballin JC. Evaluation of a new aerosolized steroid for asthma therapy. JAMA. 1976; 236:2891-3. [IDIS 66616] [PubMed 1036594]
31. Willey RF, Godden DJ, Carmichael J et al. Comparison of twice daily administration of a new corticosteroid budesonide with beclomethasone dipropionate four times daily in the treatment of chronic asthma. Br J Dis Chest. 1982; 76:61-8. [PubMed 7037035]
32. Kennedy MCS, Posner E, Thursby-Pelham DC. Long-term treatment of asthma with beclomethasone dipropionate. Postgrad Med J. 1975; 51(Suppl 4):84-6. [PubMed 812075]
33. Williams MH Jr. Beclomethasone dipropionate. Ann Intern Med. 1981; 95:464-7. [IDIS 138411] [PubMed 6792963]
34. Shim C, Stover DE, Williams MH Jr. Response to corticosteroids in chronic bronchitis. J Allergy Clin Immunol. 1978; 62:363-7. [IDIS 120228] [PubMed 361794]
35. Elkon KB, Sher R, Seftel HC. Immunological studies of eosinophilic gastroenteritis and treatment with disodium cromoglycate and beclomethasone dipropionate. S Afr Med J. 1977; 52:834-41.
36. Kumana CR, Meghji M, Seaton T et al. Beclomethasone dipropionate enemas for treating inflammatory bowel disease without producing Cushing’s syndrome or hypothalamic-pituitary-adrenal suppression. Lancet. 1982; 1:579-83. [IDIS 146782] [PubMed 6121181]
37. Matthews JI, Hooper RG. Idiopathic bronchial stenosis in a young woman. Chest. 1978; 74:690-1. [IDIS 118949] [PubMed 738131]
38. Horton DJ, Spector SL. Clinical pulmonary tuberculosis in an asthmatic patient using a steroid aerosol. Chest. 1977; 71:540-2. [IDIS 84064] [PubMed 852327]
39. Andersson E, Smidt CM, Sikjaer B et al. Bronchial biopsies after beclomethasone dipropionate aerosol. Br J Dis Chest. 1977; 77:35-43.
40. Mellis CM, Phelan PD. Asthma deaths in children—a continuing problem. Thorax. 1977; 32:29-34. [PubMed 841530]
41. Bhan GL, Gwynn CM, Smith JM. Growth and adrenal function of children on prolonged beclomethasone dipropionate treatment. Lancet. 1980; 1:96-7. [IDIS 108713] [PubMed 6101444]
42. Smith JM. Hazards of prolonged use of beclomethasone spray. JAMA. 1982; 248:1449. [IDIS 156419] [PubMed 7109163]
43. Siegel SC, Katz RM, Rachelefsky GS. Prednisone and beclomethasone for treatment of asthma. N Engl J Med. 1979; 300:986. [IDIS 93832] [PubMed 431575]
44. Clark TJH. Beclomethasone dipropionate treatment of asthma in adults. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:94-106.
45. Wyatt R, Waschek J, Weinberger M et al. Effects of inhaled beclomethasone dipropionate and alternate-day prednisone on pituitary-adrenal function in children with chronic asthma. N Engl J Med. 1978; 299:1387-92. [IDIS 91444] [PubMed 362207]
46. Vaz R, Senior B, Morris M et al. Adrenal effects of beclomethasone inhalation therapy in asthmatic children. J Pediatr. 1982; 100:660-2. [IDIS 148471] [PubMed 7062222]
47. Toogood JH, Lefcoe NM, Haines DSM et al. A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma. J Allergy Clin Immunol. 1977; 59:298-308. [IDIS 86371] [PubMed 321503]
48. Toogood JH, Jennings B, Greenway RW et al. Candidiasis and dysphonia complicating beclomethasone treatment of asthma. J Allergy Clin Immunol. 1980; 65:145-53. [IDIS 113987] [PubMed 7351447]
49. Chiu JT, Wells I, Novey HS. Incidence of fungal precipitins in patients treated with beclomethasone dipropionate aerosol. Ann Allergy. 1981; 46:137-9. [IDIS 134708] [PubMed 7008662]
50. Milne LJR, Crompton GK. Beclomethasone dipropionate and oropharyngeal candidiasis. Br Med J. 1974; 3:797-8. [IDIS 47946] [PubMed 4606264]
51. Stein MR, Shay SS, Jacobson K. Monilial esophagitis in asthmatic patients treated with beclomethasone. J Allergy Clin Immunol. 1979; 63:172.
52. Imbeau SA, Geller M. Aerosol beclomethasone treatment of chronic severe asthma—a one-year experience. JAMA. 1978; 240:1260-2. [IDIS 85908] [PubMed 682308]
53. Klotz LR, Klotz SD, Moeller RK. The use of beclomethasone dipropionate inhaler complicated by the development of an eosinophilic pneumonia reaction. Ann Allergy. 1977; 39:133-6. [IDIS 90762] [PubMed 889156]
54. Hudgel DW, Spector SL. Pulmonary infiltration with eosinophilia—recurrence in an asthmatic patient treated with beclomethasone dipropionate. Chest. 1977; 72:359-60. [IDIS 92254] [PubMed 891289]
55. Friedman H, Tworag JF, Voss HE et al. Eosinophilic pneumonia in association with the use of beclomethasone dipropionate aerosol. J Allergy Clin Immunol. 1978; 61:150.
56. Brogden RN, Pinder RM, Sawyer PR et al. Beclomethasone dipropionate inhaler: a review of its pharmacology, therapeutic value and adverse effects. Part I: asthma. Drugs. 1975; 10:166-210. [IDIS 62498] [PubMed 172309]
57. Bryant DH, Pepys J. Bronchial reactions to aerosol inhalant vehicle. Br Med J. 1976; 1:1319-20. [PubMed 1268679]
58. Kass I, Nair SV, Patil KD. Beclomethasone dipropionate aerosol treatment of steroid-dependent asthmatic patients: an assessment of 18 months of therapy. Chest. 1977; 71:703-7. [IDIS 81635] [PubMed 405181]
59. Lee-Hong E, Collins-Williams C. The long-term use of beclomethasone dipropionate for the control of severe asthma in children. Ann Allergy. 1977; 38:242-4. [PubMed 851256]
60. Cooper EJ, Grant IWB. Beclomethasone dipropionate aerosol in treatment of chronic asthma. Q J Med. 1977; 46:295-308. [IDIS 90416] [PubMed 918249]
61. USPDI: 1983 drug information for the health care provider. Johnson KW, ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1983; I:177-8.
62. Freigang B. New method of beclomethasone aerosol administration to children under 4 years of age. Can Med Assoc J. 1977; 117:1308-9. [IDIS 75131] [PubMed 922624]
63. Freigang B. Long-term follow-up of infants and children treated with beclomethasone aerosol by a special inhalation device. Ann Allergy. 1980; 45:13-7. [IDIS 119650] [PubMed 6773446]
64. Soderberg-Warner M, Siegel S, Katz R et al. Treatment of chronic childhood asthma with beclomethasone dipropionate aerosols (BDP). IV. long-term effects on growth. J Allergy Clin Immunol. 1979; 63:164.
65. Godfrey S, Balfour-Lynn L, Tooley M. A three- to five-year follow-up of the use of the aerosol steroid beclomethasone dipropionate, in childhood asthma. J Allergy Clin Immunol. 1978; 62:335-9. [IDIS 120226] [PubMed 712019]
66. Godfrey S. Beclomethasone dipropionate treatment of childhood asthma. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:123-36.
67. Anon. Management of asthma in the child aged under 6 years. BMJ. 1981; 283:863-4.
68. Schering Corporation. Vancenase prescribing information. Kenilworth, NJ; 1981 Sep.
69. Glaxo Inc. Beconase prescribing information. Fort Lauderdale, FL; 1981 Aug.
70. Brown HM, Storey G. Beclomethasone dipropionate aerosol in long-term treatment of perennial and seasonal asthma in children and adults: a report of five-and-half years experience in 600 asthmatic patients. Br J Clin Pharmacol. 1977; 3(Suppl):259-67S.
71. Schering Corporation. Vanceril oral inhaler patient instructions. Kenilworth, NJ; 1978 Aug.
72. Iezzoni DG (Schering Corporation, Kenilworth, NJ): Personal communication; 1982 Jul.
73. Gregg I. The importance of patient education in the use of inhaled steroids. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:137-42.
74. Stark JE. The clinical assessment of inhaled corticosteroids. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:77-93.
75. Laitinen LA, Haahtela T. Effect of two dosage schedules of beclomethasone dipropionate aerosol in the treatment of patients with moderately severe asthma. Curr Ther Res. 1978; 24:465-9.
76. Gaddie J, Reid IW, Skinner C et al. Aerosol beclomethasone dipropionate: a dose-response study in chronic bronchial asthma. Lancet. 1973; 2:280-1. [IDIS 41985] [PubMed 4124769]
77. Gotz VP, Lauper RD. Drug evaluation data—beclomethasone dipropionate (Vanceril inhaler–Schering). Drug Intell Clin Pharm. 1976; 10:635-7.
78. Mackay AD, Dyson AJ. How important is the sequence of administration of inhaled beclomethasone dipropionate and salbutamol in asthma. Br J Dis Chest. 1981; 75:273-6. [PubMed 7028071]
79. Martin LE, Tanner RJN, Clark TJH et al. Absorption and metabolism of orally administered beclomethasone dipropionate. Clin Pharmacol Ther. 1974; 15:267-74. [IDIS 40193] [PubMed 4815952]
80. Mazza J, Toogood JH, Jennings B et al. Importance of prolonged follow-up during steroid weaning of beclomethasone aerosol-treated asthmatic patients. J Allergy Clin Immunol. 1979; 63:164.
81. Konig P, Goldstein DE. Adrenal function after beclomethasone inhalation therapy. J Pediatr. 1982; 101:646. [IDIS 159665] [PubMed 7119974]
82. Goldstein DE, Konig P. Effect of inhaled beclomethasone dipropionate on hypothalamic-pituitary-adrenal axis function in children with asthma. Pediatrics. 1983; 72:60-4. [IDIS 172900] [PubMed 6866593]
83. Fein BT. Geriatric asthma: treatment with beclomethasone dipropionate aerosol. South Med J. 1981; 74:1186-93. [IDIS 138975] [PubMed 7292054]
84. Krumholz RA. Prospective multicentric study of clinical practice experience with beclomethasone dipropionate inhaler. J Allergy Clin Immunol. 1982; 69(Suppl):110.
85. Fuentes RJ (Glaxo Inc, Research Triangle Park, NC), and Iezzoni DG (Schering Corporation, Kenilworth, NJ): Personal communication; 1983 Jan.
86. Mygind N, Clark TJH. Safety and topical side effects. In: Mygind N, Clark TJH, eds. Topical steroid treatment for asthma and rhinitis. London: Bailliere Tindall; 1980:171-9.
87. Nassif EG, Weinberger M, Thompson R et al. The value of maintenance theophylline in steroid-dependent asthma. N Engl J Med. 1981; 304:71-5. [IDIS 125610] [PubMed 7003383]
88. Toogood JH, Jennings BH, Lefcoe NM. A clinical trial of combined cromolyn/beclomethasone treatment for chronic asthma. J Allergy Clin Immunol. 1981; 67:317-24. [IDIS 164896] [PubMed 6782146]
89. Smith MJ, Hodson ME. High-dose beclomethasone inhaler in the treatment of asthma. Lancet. 1983; 1:265-8. [IDIS 164606] [PubMed 6130294]
90. Greenberger PA, Patterson R. Beclomethasone dipropionate for severe asthma during pregnancy. Ann Intern Med. 1983; 98:478-80. [IDIS 168910] [PubMed 6838070]
91. Dolovich M, Ruffin RE, Roberts R et al. Optimal delivery of aerosols from metered dose inhalers. Chest. 1981; 80(Suppl):911-5. [IDIS 164262] [PubMed 7307637]
92. Adverse Drug Reaction Advisory Committee. Case report. Med J Aust. 1979; 1:460.
93. Meltzer EO, Kemp JP, Welch MJ et al. Effect of dosing schedule on efficacy of beclomethasone dipropionate aerosol in chronic asthma. Am Rev Respir Dis. 1985; 131:732-6. [IDIS 200272] [PubMed 4003917]
94. Munch EP, Taudorf E, Weeks B. Dose frequency in the treatment of asthmatics with inhaled topical steroid. Eur J Respir Dis. 1982; 122(Suppl):143-53.
95. Graff-Lonnevig V, Kraepelien S. Long-term treatment with beclomethasone dipropionate aerosol in asthmatic children, with special reference to growth. Allergy. 1979; 34:57-61. [PubMed 222163]
96. Jorde W, Werdermann K. Bronchial cytology after prolonged treatment with beclomethasone dipropionate. (French; translation supplied by Schering Corporation.) Nouv Presse Med. 1977; 6:1281-2.
97. Hemstreet MP, Reynolds DW, Meadows J et al. Oesophagitis—a complication of inhaled steroid therapy. Clin Allergy. 1980; 10:733-8. [PubMed 6257423]
98. Hendy P, Turner AS. Pulmonary infiltrative eosinophilia and beclomethasone dipropionate. N Z Med J. 1981; 94:394. [IDIS 147364] [PubMed 6948210]
99. Kewley GD. Possible association between beclomethasone dipropionate aerosol and cataracts. Aust Paediatr J. 1980; 16:117-8. [PubMed 7425979]
100. Iezzoni DG (Schering Corporation, Kenilworth, NJ): Personal communication; 1983 Feb.
101. Reviewers’ comments (personal observations); 1983.
102. Williams AJ, Bahgat MS, Stableforth DE et al. Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality. Thorax. 1983; 38:813-21. [PubMed 6648863]
103. Brogden RN, Heel RC, Speight TM et al. Beclomethasone dipropionate: a reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis. Drugs. 1984; 28:99-126. [IDIS 188449] [PubMed 6381025]
104. Rooklin AR, Lampert SI, Jaeger EA et al. Posterior subcapsular cataracts in steroid-requiring asthmatic children. J Allergy Clin Immunol. 1979; 63:383-6. [PubMed 447940]
105. Fuentes RJ (Glaxo Inc, Research Triangle Park, NC): Personal communication; 1983 Jul.
106. Newman SP, Pavia D, Clarke SW. How should a pressurized β-adrenergic bronchodilator be inhaled? Eur J Respir Dis. 1981; 62:3-21.
107. Lawford P, McKenzie D. Pressurized bronchodilator aerosol technique: influence of breath-holding time and relationship of inhaler to the mouth. Br J Dis Chest. 1982; 76:229-33. [PubMed 7126435]
108. Unzeitig J, Richards W, Church JA. Comparison of aerosol inhalation techniques. J Allergy Clin Immunol. 1983; 71:150.
109. Mitchell I, Paterson IC, Cameron SJ et al. Treatment of childhood asthma with sodium cromoglycate and beclomethasone dipropionate aerosol singly and in combination. Br Med J. 1976; 4:457-8.
110. Rachelefsky GS, Siegel SC. Revisited: aerosol corticosteroids in the treatment of childhood asthma. Pediatrics. 1983; 72:130-1. [IDIS 172904] [PubMed 6866582]
111. Harris DM, Martin LE, Harrison C et al. The effect of intranasal beclomethasone dipropionate on adrenal function. Clin Allergy. 1974; 4:291-4. [PubMed 4426111]
112. Schering Corporation. Vanceril prescribing information. Kenilworth, NJ; 1981 Jun.
113. Glaxo Inc. Beclovent prescribing information. Fort Lauderdale, FL; 1980 Jun.
114. Poynter D, Spurling NW, Ainge G. A toxicity study with beclomethasone dipropionate in the dog with particular reference to the respiratory tract. Postgrad Med J. 1975; 51(Suppl 4):27-9. [PubMed 1197192]
115. Hodder R. Aerosol advertising: misleading the puffers. N Z Med J. 1979; 90:213. [PubMed 292864]
116. Broder I, Tarlo SM, Davies GM et al. Safety and efficacy of long-term treatment with inhaled beclomethasone dipropionate in steroid-dependent asthma. CMAJ. 1987; 136:129-35. [IDIS 225097] [PubMed 3098400]
117. Shim CS, Williams MH Jr. Aerosol beclomethasone in patients with steroid-responsive chronic obstructive pulmonary disease. Am J Med. 1985; 78:655-8. [IDIS 198715] [PubMed 3985039]
118. Robertson AS, Gove RI, Wieland GA et al. A double-blind comparison of oral prednisolone 40 mg/day with inhaled beclomethasone dipropionate 1500 mcg/day in patients with adult onset chronic obstructive airways disease. Eur J Respir Dis. 1986; 69(Suppl 146):565-9.
119. Smith MJ, Hodson ME. Effects of long term inhaled high dose beclomethasone dipropionate on adrenal function. Thorax. 1983; 38:676-81. [PubMed 6684806]
120. Pils NHJ, Driessen MNBM. Suppression of pituitary-adrenal axis in children on beclomethasone dipropionate inhalation therapy. Lancet. 1984; 2:174-5.
121. Law CM, Marchant JL, Honour JW et al. Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet. 1986; 1:942-4. [IDIS 215673] [PubMed 2871242]
122. Fitzsimons R, Greenberger PA, Patterson R. Outcome of pregnancy in women requiring corticosteroids for severe asthma. J Allergy Clin Immunol. 1986; 78:349-53. [IDIS 220781] [PubMed 3734287]
123. Boyd G, Abdallah S, Clark R. Twice or four times daily beclomethasone dipropionate in mild stable asthma? Clin Allergy. 1985; 15:383-9.
124. Katz RM, Rachelefsky GS, Siegel SC et al. Twice-daily beclomethasone dipropionate in the treatment of childhood asthma. J Asthma. 1986; 23:1-7. [PubMed 2875059]
125. Williams H, Jones ERV, Sibert JR. Twice daily versus four times daily treatment with beclomethasone dipropionate in the control of mild childhood asthma. Thorax. 1986; 41:602-5. [PubMed 3538486]
126. Tukiainen H, Vaara J, Terho E et al. Comparison of twice-daily and four-times daily administration of beclomethasone dipropionate in patients with severe chronic bronchial asthma. Eur J Clin Pharmacol. 1986; 30:319-22. [IDIS 219300] [PubMed 3732368]
127. Muers M, Dawkins K. Effect of a timed interval between inhalation of beta-agonist and corticosteroid aerosols on the control of chronic asthma. Thorax. 1983; 38:378-82. [PubMed 6348995]
128. Pover GM, Greger G, Kaspar P. Comparison of the effects of sequential or simultaneous administration of salbutamol and beclomethasone dipropionate. Respiration. 1986; 50:83-7. [PubMed 3749616]
129. Francis RS. Adrenocortical function during high-dose beclomethasone aerosol therapy. Clin Allergy. 1984; 14:49-53. [PubMed 6697473]
130. Smith MJ. The place of high-dose inhaled corticosteroids in asthma therapy. Drugs. 1987; 33:423-9. [IDIS 231487] [PubMed 3297619]
131. Shim C, Williams MH Jr. Cough and wheezing from beclomethasone aerosol. Chest. 1987; 91:207-9. [IDIS 226282] [PubMed 3802930]
132. Shim CS, Williams MH Jr. Cough and wheezing from beclomethasone dipropionate aerosol are absent after triamcinolone acetonide. Ann Intern Med. 1987; 106:700-3. [IDIS 229432] [PubMed 3565967]
133. Godin J, Malo JL. Acute bronchoconstriction caused by Beclovent and not Vanceril. Clin Allergy. 1979; 9:585-9. [PubMed 519839]
134. Anon. Revised label warns of severe viral problems with corticosteroids. FDA Med Bull. 1991 Dec; 21:3.
135. Peterson F (US Food and Drug Administration). Corticosteroid drugs and chickenpox. Rockville, MD; 1991 Dec 2. Press release no. P91-31 (from FDA electronic bulletin board).
136. Jones JF. FDA varicella warning. Pediatrics. 1992; 90:480-1.
137. Kasper WJ, Howe PM. Fatal varicella after a single course of corticosteroids. Pediatr Infect Dis. 1990; 9:729-32.
138. Close GC, Houston IB. Fatal hemorrhagic chickenpox in a child on long term steroids. Lancet. 1981; 2:480. [IDIS 136447] [PubMed 6115244]
139. Gershon A, Brunell PA, Doyle E. Steroid therapy and varicella. J Pediatr. 1972; 81:1034. [PubMed 4117587]
140. Lantner R, Rockoff JB, DeMasi J et al. Fatal varicella in a corticosteroid-dependent asthmatic receiving troleandomycin. Allergy Proc. 1990; 11:83-7. [PubMed 2338242]
141. Silk HJ, Guay-Woodford L, Perez-Atayde AR et al. Fatal varicella in steroid-dependent asthma. J Allergy Clin Immunol. 1988; 81:47-51. [IDIS 316649] [PubMed 3339190]
142. Schering Corporation. Vancenase (beclomethasone dipropionate) Pockethaler nasal inhaler prescribing information, dated 1992 Mar. In: Physicians’ desk reference. 47th ed. Montvale, NJ: Medical Economics Company Inc; 1993:2220-1.
143. Allen & Hanburys, Division of Glaxo Inc. Beconase (beclomethasone dipropionate) inhalation aerosol and Beconase AQ (beclomethasone dipropionate, monohydrate) nasal spray prescribing information. In: Physicians’ desk reference. 47th ed. Montvale, NJ: Medical Economics Company Inc; 1993:575-7.
144. Key. Vanceril (beclomethasone dipropionate) 84 mcg double-strength prescribing information. Kenilworth, NJ. 1996 Dec.
145. National Asthma Education and Prevention Program. Expert panel report II: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health; 1997 Feb.
146. National Asthma Education Program. Executive summary: guidelines for the diagnosis and managment of asthma. NIH Publication No. 94-3042A. Washington, DC: US Governement Printing Office; 1994 Jul.
147. National Institutes of Health, National Heart, Lung, and Blood Institute. Global initiative for asthma: global strategy for asthma management and prevention NHLBI/WHO Workshop Report. Bethesda, MD: National Institutes of Health. 2002 Feb. NIH/NHLBI Publication No. 02-3659. Available at: http://www.ginasthma.com. Accessed Sep. 26, 2002.
148. British Thoracic Society. Guidelines on the management of asthma. Thorax. 1993; 48(Suppl 2):S1-24.
149. 3M Pharmaceuticals. QVAR prescribing information. Northridge, CA; 2002 May.
150. Pedersen S. Assessing the effect of intranasal steroids on growth. J Allergy Clin Immunol. 2001; 108:S40-4. [IDIS 467845] [PubMed 11449205]
151. Skoner D. Update of growth effects of inhaled and intranasal corticosteroids. Curr Opin Allergy Clin Immunol. 2002; 2:7-10. [PubMed 11964744]
152. National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma update on selected topics—2002. J Allergy Clin Immunol. 2002; 110(Suppl.5):S141-219.
153. Vanden Burgt JA, Busse WW, Martin RJ, et al. Efficacy and safety overview of a new inhaled corticosteroid, QVAR (hydrofluoroalkane-beclomethasone extrafine inhalation aerosol), in asthma. J Allergy Clin Immunol. 2000;106:1209-26.
154. Fireman P, Prenner BM, Vincken W, et al. Long-term safety and efficacy of a chlorofluorocarbon-free beclomethasone dipropionate extrafine aerosol. Ann Allergy Asthma Immunol. 2001; 86: 557-65.
155. Gross G, Thompson PJ, Chervisnky P, et al. and the Study Group. Hydrofluoroalkane-134a beclomethasone dipropionate, 400 mcg, is as effective as chlorofluorocarbon beclomethasone dipropionate, 800 mcg, for the treatment of moderate asthma. Chest. 1999; 115:343-51.
156. Nayak A, Lanier R, Weinstein S, et al. Efficacy and safety of beclomethasone dipropionate extrafine aerosol in childhood asthma. A 12-week, randomized, double-blind, placebo-controlled study. Chest. 2002; 122:1956-65.
157. Busse WW, Brazinsky S, Jacobson K, et al. Efficacy response of inhaled beclomethasone dipropionate in asthma is proportional to dose and is improved by formulation with a new propellant. J Allergy Clin Immunol. 1999; 104: 1215-22.
158. Harrison LI, Colice GL, Donnell D, et al. Adrenal effects and pharmacokinetics of CFC-free beclomethasone dipropionate: a 14-day dose-response study. J Pharm Pharmacol. 1999; 51:263-269.
159. Leach CL, Davidson PJ, Hasselquist BE, et al. Lung deposition of hydrofluoroalkane-134a beclomethasone is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone. A cross-over study in healthy volunteers. Chest. 2002; 122:510-6.
160. Ivax Pharmaceuticals, Inc. Miami, FL: Personal communication.
163. National Institutes of Health, National Heart, Lung, and Blood Institute. Global initiative for asthma: global strategy for asthma management and prevention. Bethesda, MD: National Institutes of Health. 2009 Dec. Available from: Accessed 2010 Sep 23.
a. AHFS drug information 2004. McEvoy GK, ed. Corticosteroids general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004:2886-98.
b. 3M Pharmaceuticals. QVAR (beclomethasone dipropionate) inhalation aerosol patient instructions. Northridge, CA; 2002 May.
c. AHFS drug information 2004. McEvoy GK, ed. Beclomethasone Dipropionate. Bethesda, MD: American Society of Health-System Pharmacists; 2004:2658-62.