Inhaled corticosteroids (ICS)
ATC code: R03BA05 (Fluticasone)
Brand names
Flovent, Advair
High-affinity glucocorticoid receptor agonist with pronounced anti-inflammatory activity in the airways. Local potency is 1.5–2 fold higher than budesonide at equivalent doses. Systemic bioavailability after inhalation is below 1 %. Twice-daily dosing. Available as pMDI, DPI, and in fixed combinations with salmeterol (Seretide) and vilanterol (Relvar).
First line
Asthma controller per 2024. Regular twice-daily dosing. Mild-to-moderate asthma: 100–250 mcg twice daily; severe asthma: up to 500 mcg twice daily. Most patients are optimally treated with a fixed-dose combination with LABA (fluticasone/salmeterol, fluticasone/vilanterol). Children over 4 years: 50–200 mcg twice daily.
Individual decision
Per 2024, ICS in COPD is reserved for subgroups with frequent exacerbations or eosinophilia. The TORCH trial with fluticasone/salmeterol showed reduced exacerbations and potentially reduced mortality but raised pneumonia risk. In patients without ICS indications, dual bronchodilation is preferred.
ICS in COPD only with frequent exacerbations or blood eosinophils ≥ 300/μL.
Not recommended
— Nebulized inhaled corticosteroids for adult acute respiratory infections: Nebulized fluticasone propionate is used in adults for acute cough, laryngitis and bronchitis during a viral respiratory infection without an asthma or COPD diagnosis – particularly by Russian ENT specialists and pediatricians. 2024, ERS/ATS, and NG143 do not support this use – ICS are indicated for established obstructive airway disease. The evidence base for adult URTI without obstruction is absent, and local adverse effects (oral candidiasis, dysphonia) are not justified.
FDA categories were retired in 2015. Do not withdraw ICS in pregnant asthma patients. Systemic exposure after inhalation is minimal. Pregnancy data for fluticasone are smaller than for budesonide — in ICS-naive pregnant patients, budesonide is often preferred.
Compatible with breastfeeding.
fluticasone propionate is evaluated for the following indications with varying evidence strength: Asthma (evidence tier A), Chronic obstructive pulmonary disease (evidence tier B), Non-specific immune boosting and respiratory infection prevention (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of fluticasone propionate (≥ 1 in 100): Oral candidiasis, Dysphonia, Throat irritation, Post-inhalation cough. See the Safety section for uncommon and serious reactions.
FDA categories were retired in 2015. Do not withdraw ICS in pregnant asthma patients. Systemic exposure after inhalation is minimal. Pregnancy data for fluticasone are smaller than for budesonide — in ICS-naive pregnant patients, budesonide is often preferred.
Compatible with breastfeeding.
fluticasone propionate is contraindicated in: Hypersensitivity; Active pulmonary tuberculosis; Systemic fungal infections. Full list in the Safety section.