What is the recommended dose and treatment regimen for nebulized budesonide (corticosteroid) in patients with asthma?

From the Guidelines

The recommended dose of nebulized budesonide for asthma treatment should be carefully titrated to the minimum dose required to maintain control, with the dose administered 2 times daily. When determining the dose, the clinician's judgment of the patient's response to therapy is the most important determinant of appropriate dosing 1. For children <4 years of age, budesonide nebulizer suspension is the only ICS with FDA-approved labeling, and the dose should be delivered through a face mask that fits snugly over the nose and mouth, avoiding nebulization in the eyes 1. Key considerations for treatment include:

• Using only jet nebulizers, as ultrasonic nebulizers are ineffective for suspensions 1
• Compatibility of budesonide suspension with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1
• Rinsing the face after each treatment to prevent local side effects 1
• Assessing treatment response after 2-4 weeks and adjusting the dose accordingly to achieve the minimum effective dose.

From the FDA Drug Label

The recommended starting dose and highest recommended dose of budesonide inhalation suspension, based on prior asthma therapy, are listed in the following table. Previous Therapy Recommended Starting Dose Highest Recommended Dose Bronchodilators Alone 0.5 mg total daily dose administered twice daily in divided doses 0.5 mg total daily dose Inhaled Corticosteroids 0. 5 mg total daily dose administered twice daily in divided doses 1 mg total daily dose Oral Corticosteroids 1 mg total daily dose administered as 0.5 mg twice daily 1 mg total daily dose Dosing recommendations based on previous therapy are as follows: 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 Oral corticosteroids: 0.5 mg twice daily In symptomatic children not responding to non-steroidal therapy, a starting dose of 0. 25 mg once daily may be considered. If once-daily treatment does not provide adequate control, the total daily dose should be increased and/or administered as a divided dose. In all patients, it is desirable to downward-titrate to the lowest effective dose once asthma stability is achieved.

The recommended dose and treatment regimen for nebulized budesonide in patients with asthma is as follows:

• Starting dose: 0.5 mg once daily or 0.25 mg twice daily for patients on bronchodilators alone, 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily for patients on inhaled corticosteroids, and 0.5 mg twice daily for patients on oral corticosteroids.
• Highest recommended dose: 0.5 mg total daily dose for patients on bronchodilators alone, 1 mg total daily dose for patients on inhaled corticosteroids, and 1 mg total daily dose for patients on oral corticosteroids.
• Dose titration: If once-daily treatment does not provide adequate control, the total daily dose should be increased and/or administered as a divided dose. In all patients, it is desirable to downward-titrate to the lowest effective dose once asthma stability is achieved 2.

From the Research

Nebulized Budesonide in Asthma Treatment

• The recommended dose and treatment regimen for nebulized budesonide in patients with asthma is not explicitly stated in the provided studies, but various studies compare the efficacy of budesonide with other corticosteroids in asthma treatment 3, 4, 5.
• A study comparing fluticasone and budesonide found that fluticasone was associated with significantly greater improvement in lung function and better asthma symptom control than budesonide 4.
• Another study found that nebulized budesonide achieved a reduced specific airway resistance and improved forced expiratory volume in 1 sec, with greater efficacy than fluticasone in infantile asthma 5.
• In the treatment of COPD exacerbations, high-dose nebulized budesonide was found to be noninferior to systemic corticosteroids in improving FEV1 and PaCO2, but of inferior efficacy for PaO2 changes 6.
• The use of nebulized budesonide in combination with systemic corticosteroid was found to have no additional effect over the use of hydrocortisone alone in adults with acute asthma managed in the emergency department 7.

Key Findings

• Nebulized budesonide is effective in improving lung function and symptom control in asthma patients 4, 5.
• The efficacy of budesonide may vary depending on the population and disease severity, with some studies suggesting greater efficacy in infantile asthma 5.
• High-dose nebulized budesonide may be an acceptable alternative to systemic corticosteroids in hospitalized patients with COPD exacerbations who are not critically ill 6.
• Further studies are needed to determine the optimal dose and treatment regimen for nebulized budesonide in asthma patients 3, 4, 5, 6.