From the Guidelines
Pulmicort (budesonide) is typically prescribed at doses of 200 mcg twice daily for adults with mild persistent asthma, as evidenced by the IMPACT study 1. For children, the usual dose ranges from 0.5-1 mg daily divided into 1-2 doses, but specific dosing for Pulmicort in children under 12 is not well established in the provided guidelines. When using the inhaler, it is essential to shake it well before each use, rinse your mouth after administration to prevent thrush, and allow 1 minute between puffs if multiple inhalations are prescribed. Pulmicort is a corticosteroid that works by reducing inflammation in the airways, making breathing easier. It's crucial to use Pulmicort regularly as prescribed, even when feeling well, as it's a controller medication that prevents symptoms rather than providing immediate relief during an asthma attack. Full effects may take 1-2 weeks to develop. If you're switching from oral steroids to Pulmicort, your doctor will typically taper the oral dose gradually to avoid withdrawal symptoms, as noted in guidelines for asthma management 1. Key points to consider when prescribing Pulmicort include:
- Asthma severity and previous steroid use influence the dose
- Regular use is necessary for optimal control of symptoms
- Potential side effects, such as oral thrush, must be monitored and prevented with proper inhaler technique
- The medication's full effects may take time to develop, emphasizing the importance of adherence to the prescribed regimen.
From the FDA Drug Label
The efficacy of budesonide inhalation suspension at doses of 0.25 mg and 0.5 mg twice daily was evaluated in 133 pediatric asthma patients, 4 to 8 years of age, previously maintained on inhaled corticosteroids. Budesonide inhalation suspension at doses of 0.25 mg once daily, 0.25 mg twice daily, 0.5 mg twice daily, and 1 mg once daily was evaluated in 469 pediatric patients 12 months to 8 years of age. Budesonide inhalation suspension at doses of 0.25 mg and 0.5 mg twice daily and 1 mg once daily, demonstrated statistically significant decreases in nighttime asthma symptom scores compared to placebo.
The recommended dose of Pulmicort (budesonide inhalation suspension) is:
- 0.25 mg to 0.5 mg twice daily
- 1 mg once daily The frequency of administration is either once daily or twice daily 2.
From the Research
Pulmicort Dose and Frequency
- The Pulmicort dose and frequency are not explicitly stated in the provided studies, but we can look at the doses of budesonide used in the studies:
- In the study by 3, budesonide/formoterol 640 microg/18 microg per day and budesonide/formoterol 320 microg/9 microg per day plus additional inhalations as needed were used.
- In the study by 4, budesonide/formoterol 160/4.5 microg two inhalations twice daily and as needed was used.
- In the study by 5, budesonide/salmeterol in fixed-dose combination was provided as powder in hard capsules of two strengths: 120/20μg and 240/20μg when expressed as delivered doses, equivalent to 150/25μg and 300/25μg when expressed as nominal doses.
Budesonide/Formoterol Maintenance and Reliever Therapy
- Budesonide/formoterol maintenance and reliever therapy has been shown to be effective in reducing the incidence of severe asthma exacerbations and hospitalization/ER treatment compared to fixed-dose inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) regimens 3, 4, 6.
- This therapy has also been shown to provide similar improvements in lung function, asthma control days, and asthma-related quality of life compared to fixed-dose ICS/LABA regimens 3, 4.
Comparison with Other Treatments
- Budesonide/formoterol has been compared to salmeterol/fluticasone propionate in several studies, with mixed results 3, 7, 4.
- The study by 7 found that fluticasone/salmeterol and budesonide/formoterol had similar efficacy in terms of lung function outcomes, symptoms, and rescue medication use.
- The study by 4 found that budesonide/formoterol maintenance and reliever therapy reduced total exacerbations and exacerbations requiring hospitalization/emergency room treatment compared to salmeterol/fluticasone propionate.