From the Guidelines
The low dose of inhaled budesonide for adults is typically 200-400 micrograms per day, usually divided into two daily doses, as recommended by recent guidelines 1. For children, the low dose range is generally 100-200 micrograms per day. Budesonide is available in various inhaler devices, including metered-dose inhalers (MDIs) and dry powder inhalers like Turbuhaler or Flexhaler. When using an MDI, it's essential to use a spacer device to improve medication delivery to the lungs and reduce the risk of side effects like oral thrush, as suggested by studies 1. Patients should rinse their mouth after each use to further minimize this risk. Budesonide works by reducing inflammation in the airways, which helps control asthma symptoms and prevent exacerbations. It does this by suppressing the activity of inflammatory cells and reducing the production of inflammatory mediators in the lungs. The medication typically takes several days to reach full effectiveness, so it should be used regularly as prescribed, even when symptoms are not present. Some key points to consider when prescribing budesonide include:
- Monitoring response to therapy closely, especially in young children, as treatment is often in the form of a therapeutic trial 1
- Considering alternative therapies or diagnoses if a clear and beneficial response is not obvious within 4 to 6 weeks 1
- Stepping down therapy after a sustained beneficial response for at least 3 months to evaluate the need for continued daily long-term control therapy 1 Low-dose inhaled corticosteroids like budesonide are generally considered safe for long-term use with minimal systemic side effects compared to oral corticosteroids. However, it's crucial to weigh the benefits against potential risks, such as a small, nonprogressive reduction in growth velocity in children, and to titrate the dose to as low as needed to maintain control 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Recommended dosing based on previous therapy ( 2). Start with the lowest recommended dose: Bronchodilators alone: 0. 5 mg once daily or 0.25 mg twice daily Inhaled corticosteroids: 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily The low dose of inhaled corticosteroid Budesonide is 0.25 mg once daily or 0.25 mg twice daily 2.
- The dose can be increased if necessary, but it is recommended to start with the lowest recommended dose.
- The dose should be titrated downwards once asthma stability is achieved.
From the Research
Low Dose Inhaled Corticosteroid Dose of Budesonide
- The effectiveness of low-dose inhaled budesonide has been studied in various research papers 3, 4, 5, 6, 7.
- A study published in Respiratory medicine in 2000 compared the effects of high and low dose inhaled steroid, budesonide, in patients with newly detected asthma, and found that the low dose may not be enough to suppress asthmatic inflammation despite good clinical primary response 3.
- Another study published in Chest in 2000 found that low-dose budesonide with the addition of an increased dose during exacerbations is effective in long-term asthma control 4.
- A review published in Naunyn-Schmiedeberg's archives of pharmacology in 2008 suggested that low-dose inhaled corticosteroids, given on a daily basis, can be effective in controlling symptoms and signs of asthma, especially when disease is of recent onset 5.
- A study published in The European respiratory journal in 1998 found that low doses of inhaled budesonide, given once or twice daily, provided protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function 6.
- A review published in The Journal of asthma in 2010 found that budesonide/formoterol inhalation aerosol is an effective and well-tolerated treatment for persistent asthma in patients whose asthma cannot be controlled by an inhaled corticosteroid alone 7.
Key Findings
- Low-dose inhaled budesonide can be effective in controlling symptoms and signs of asthma, especially when disease is of recent onset 5.
- The addition of an increased dose of budesonide during exacerbations can be beneficial in long-term asthma control 4.
- Low doses of inhaled budesonide can provide protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function 6.
- Budesonide/formoterol inhalation aerosol is an effective and well-tolerated treatment for persistent asthma in patients whose asthma cannot be controlled by an inhaled corticosteroid alone 7.