From the Guidelines
Pulmicort (budesonide) is not the preferred treatment for acute asthma exacerbations in pediatric patients, but rather for long-term control and prevention of symptoms. According to the most recent and highest quality study 1, the management of asthma exacerbations in children is highly variable, and there is a need for comprehensive and updated guidelines. However, for acute asthma attacks, rescue medications like albuterol are more appropriate as they work quickly to open airways.
Key Points to Consider
- Pulmicort is a preventive corticosteroid inhaler that reduces airway inflammation over time, typically used daily as maintenance therapy 2.
- For acute asthma attacks, rescue medications like albuterol (a short-acting bronchodilator) are more appropriate as they work quickly to open airways.
- Pulmicort comes in different forms including inhalers and nebulizer suspensions, with dosing varying by age and severity (typically 0.25-1mg daily for nebulized forms or 1-2 puffs twice daily for inhalers) 2.
- Parents should understand that Pulmicort must be used consistently to be effective, and children should rinse their mouth after use to prevent thrush.
- While it's an important part of long-term asthma management, always have a rescue medication available for sudden symptoms, and work with a healthcare provider to develop a comprehensive asthma action plan.
Important Considerations for Treatment
- Inhaled corticosteroids, such as Pulmicort, are the preferred long-term control medication for initiating therapy in pediatric patients with asthma 2.
- The benefits of inhaled corticosteroids outweigh any concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects 2.
- Treatment of young children is often in the form of a therapeutic trial, and response to therapy should be monitored closely 2.
From the FDA Drug Label
Budesonide inhalation suspension is NOT indicated for the relief of acute bronchospasm The use of budesonide inhalation suspension is contraindicated in the following conditions: Primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required
Budesonide (Pulmicort) is not effective for treating acute asthma exacerbations in pediatric patients, as it is not indicated for the relief of acute bronchospasm and is contraindicated for primary treatment of status asthmaticus or other acute episodes of asthma 3.
From the Research
Efficacy of Pulmicort (Budesonide) in Treating Acute Asthma Exacerbations in Pediatric Patients
- Pulmicort (Budesonide) has been shown to be effective in treating acute asthma exacerbations in pediatric patients, with studies demonstrating its efficacy in improving pulmonary index scores and peak expiratory flow rates 4.
- A short-term dose schedule of inhaled budesonide turbohaler, starting with a high dose and followed by a decrease over 1 week, has been found to be at least as effective as oral prednisolone in treating moderately severe asthma attacks in children 4.
- Budesonide inhalation suspension has also been shown to be effective in treating young children with inhaled steroid-dependent, persistent asthma, with improvements in nighttime and daytime asthma symptom scores, use of rescue medication, and pulmonary function tests 5.
Comparison with Other Treatments
- Budesonide inhalation suspension has been compared to montelukast in young children with mild persistent asthma, with results showing that budesonide may have a longer time to first additional medication for asthma worsening and lower exacerbation rates 6.
- The use of corticosteroids, including budesonide, in the treatment of asthma in pediatric patients has been discussed in recent reviews, highlighting the importance of guideline-based approaches and the role of pharmacists in providing education and recommending evidence-based treatment options 7, 8.
Safety and Tolerability
- Budesonide has been shown to have a favorable safety profile in pediatric patients, with no significant differences in adverse events or changes in baseline and adrenocorticotrophic hormone-stimulated plasma cortisol levels compared to placebo 5.
- The use of budesonide in pediatric patients has also been associated with a lower risk of suppressing serum cortisol concentration compared to oral prednisolone 4.