Inhaled Corticosteroid (ICS) Pregnancy: Safe — ICS should be continued in pregnancy; poorly controlled asthma is more harmful than ICS; beclometasone and budesonide have most pregnancy safety data

Beclometasone Dipropionate Inhaler

Brand names: QVAR (fine-particle), Clenil Modulite, Becotide

Adult dose

Dose: QVAR: 50–200 mcg twice daily (low-medium dose). Clenil Modulite: 100–400 mcg twice daily

Route: Inhaled (MDI — metered dose inhaler)

Frequency: Twice daily

Max: QVAR: 400 mcg/day; Clenil: 800 mcg/day

ICS for persistent asthma (GINA Step 2+). QVAR uses HFA propellant producing fine-particle aerosol — deposits deeper in small airways; ~50% lower mcg dose delivers equivalent efficacy to standard MDI preparations. NOT interchangeable with Clenil Modulite on a mcg-per-mcg basis — specify brand.

Paediatric dose

Dose: QVAR: 50–100 mcg twice daily (children ≥5 years). Clenil: 100–200 mcg twice daily mcg/kg

Route: Inhaled MDI (+ spacer for children <8 years)

Frequency: Twice daily

Max: QVAR: 200 mcg/day; Clenil: 400 mcg/day in children

BNFc: QVAR licensed from 5 years; Clenil Modulite from 5 years. Spacer mandatory for children under 8 years and recommended for all children. Rinse mouth after each use.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required (minimal systemic absorption)

Paediatric weight-based calculator

Patient weight (kg)

BNFc: QVAR licensed from 5 years; Clenil Modulite from 5 years. Spacer mandatory for children under 8 years and recommended for all children. Rinse mouth after each use.

Clinical pearls

QVAR vs Clenil: QVAR is a fine-particle formulation — 100 mcg QVAR ≈ 200 mcg Clenil for clinical effect; NEVER switch between brands without dose adjustment
Rinse mouth with water and spit after each use — prevents oropharyngeal candidiasis (local deposition of steroid promotes Candida growth)
Spacer device (Volumatic, AeroChamber): reduces oropharyngeal deposition and systemic absorption — improves lower airway delivery; recommended for all patients especially children
ICS dose equivalence (approximate): low dose QVAR 200 mcg/day = budesonide 400 mcg/day = fluticasone 200 mcg/day
GINA 2024: low-dose ICS is step 2 for persistent asthma — beclometasone, budesonide, or fluticasone propionate all first-line options
Growth monitoring in children on ICS: annual height measurement; use lowest effective dose

Contraindications

Hypersensitivity to beclometasone or excipients (QVAR contains ethanol — caution in alcohol hypersensitivity)
Active TB (untreated)

Side effects

Oropharyngeal candidiasis (oral thrush)
Dysphonia (hoarse voice)
Cough on inhalation (MDI)
HPA axis suppression (high doses)
Osteoporosis (high doses, prolonged)
Growth suppression (children — high doses)

Interactions

Ketoconazole, itraconazole — increase systemic beclometasone exposure (CYP3A4 inhibition)

Monitoring

Symptom control (ACQ, ACT scores)
PEFR diary
Annual review — inhaler technique, concordance
Growth (children)
HPA axis (high-dose prolonged use)

Reference: BNFc; BNF 90; BNFc; GINA 2024; BTS/SIGN Asthma Guidelines 2019; NICE NG80. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Budesonide (Inhaled) · Inhaled Corticosteroid (ICS)

Pathways