What is the proper use and dosage of budesonide (inhalation corticosteroid) for children?

From the Guidelines

Budesonide inhalation corticosteroid for children should be dosed according to age and severity of respiratory condition, with the most recent guidelines suggesting a dose of 1 mg, twice daily for 7 days at the first sign of respiratory tract infection-associated symptoms for children aged 0 to 4 years, as recommended by the 2020 focused updates to the asthma management guidelines 1. For children 6-11 years old with asthma, the typical starting dose is 180-400 mcg twice daily via inhaler, while younger children (6 months to 5 years) usually receive 0.25-0.5 mg once or twice daily via nebulizer. Some key points to consider when using budesonide in children include:

• The medication should be administered regularly as prescribed, not just during symptoms, as it works by reducing airway inflammation over time.
• After inhalation, children should rinse their mouth with water to prevent oral thrush.
• Parents should expect gradual improvement over 1-2 weeks rather than immediate relief.
• Side effects may include hoarseness, throat irritation, and oral fungal infections.
• Budesonide is not for acute symptom relief but rather for long-term control, so a rescue inhaler should also be available.
• The medication works by reducing inflammation in the airways, decreasing mucus production, and preventing asthma attacks by suppressing the immune response in the lungs. It's also important to note that the decision to start long-term daily therapy should be based on consideration of issues regarding diagnosis and prognosis, and that initiating long-term control therapy will depend on consideration of the possible long-term effects of inadequately controlled asthma vs. the possible adverse effects of medications given over prolonged periods, as stated in the expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007 1. Additionally, the patient's response to therapy should be monitored carefully, and treatment should be stopped if a clear beneficial effect is not obvious within 4 to 6 weeks, as recommended by the expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007 1. In terms of delivery devices, several options are available, and the doses received may vary considerably among devices and age groups, with children <4 years of age having less difficulty with a face mask and either a nebulizer or an MDI with a VHC, as stated in the expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007 1. Overall, the use of budesonide in children requires careful consideration of the individual child's needs and response to therapy, as well as close monitoring for potential side effects, as recommended by the statement on the care of the child with chronic lung disease of infancy and childhood 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 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. Once asthma stability is achieved, titrate the dose downwards. For inhalation use via compressed air driven jet nebulizers only (not for use with ultrasonic devices). Not for injection. ( 2. 2)

The proper use and dosage of budesonide (inhalation corticosteroid) for children is as follows:

• Starting dose: 0.25 mg to 0.5 mg once daily or 0.25 mg twice daily, depending on previous therapy.
• Administration: Via compressed air driven jet nebulizers only.
• Dose titration: Increase or divide the dose if once-daily treatment does not provide adequate control, and titrate downwards once asthma stability is achieved.
• Age range: Approved for children 12 months to 8 years of age for maintenance treatment of asthma and as prophylactic therapy 2.

From the Research

Proper Use of Budesonide Inhaler for Children

The proper use and dosage of budesonide (inhalation corticosteroid) for children can be summarized as follows:

• Budesonide inhalation suspension is suitable for use in infants, children, and adults with persistent asthma 3.
• The recommended dosage for children varies depending on the severity of asthma and the child's age.
• For infants and young children with persistent asthma, a dosage of 0.5 to 2 mg/day has been shown to be effective in reducing day- and night-time symptom scores and the number of days in which beta2-agonist bronchodilators were required 3.
• In children with acute asthma or wheezing, budesonide inhalation suspension has been shown to be as effective as, or more effective than, oral prednisolone in improving symptoms 3.
• A study found that budesonide inhalation suspension doses of 0.25 mg, 0.50 mg, or 1.0 mg twice daily were effective in improving nighttime and daytime asthma symptom scores, reducing use of breakthrough medication, and improving morning peak expiratory flow in children with inhaled steroid-dependent, persistent asthma 4.

Dosage and Administration

The dosage and administration of budesonide inhaler for children can be summarized as follows:

• Budesonide can be delivered effectively via a dry powder inhaler (Pulmicort Turbuhaler) in patients aged > 6 years or as an inhalation suspension (Pulmicort Respules) in children as young as 12 months 5.
• Once-daily administration of budesonide has been shown to be effective in patients with mild-to-moderate asthma and is equally effective when given in the morning or evening 6.
• The frequency of adverse events was similar in children receiving budesonide inhalation suspension 0.25 to 2 mg/day or placebo in 12-week studies 3.

Safety and Efficacy

The safety and efficacy of budesonide inhaler for children can be summarized as follows:

• Budesonide has been demonstrated to be well tolerated in the treatment of chronic asthma in patients as young as 12 months 5.
• At doses required to treat mild or moderate persistent asthma, budesonide does not affect hypothalamic-pituitary-adrenal axis function, bone mineral density, cataract formation, or final adult height 5.
• Budesonide is effective and well tolerated in the control of mild-to-moderate persistent asthma in patients aged 12 months and older 5.