Budesonide MDI Dosage and Usage in Australia
In Australia, budesonide metered-dose inhaler (MDI) is recommended at doses of 200-400 mcg twice daily for adults and 100-200 mcg twice daily for children with persistent asthma, with dose adjustments based on asthma severity and control.
Dosage Recommendations
Adults and Adolescents (≥12 years)
- Initial dose: 200-400 mcg twice daily
- Maintenance dose: 100-800 mcg twice daily depending on asthma severity
- Maximum dose: 1600 mcg per day in severe cases
Children (5-11 years)
- Initial dose: 100-200 mcg twice daily
- Maintenance dose: Adjust based on response
- Maximum dose: 400 mcg twice daily
Children (0-4 years)
- Budesonide nebulizer suspension is preferred over MDI for this age group
- If MDI is used with appropriate spacer and face mask: 100-200 mcg twice daily
Administration Guidelines
- Shake the inhaler well before each use
- Use with a spacer device to improve lung deposition, especially in children
- Rinse mouth after each use to prevent oral candidiasis
- For children under 4 years, use a face mask that fits snugly over nose and mouth 1
Dosing Strategy
- Once control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 1
- Twice-daily dosing is as effective as four-times daily dosing and may improve patient compliance 2
- Once-daily dosing may be considered for mild asthma once control is established 3
Clinical Efficacy
Budesonide MDI achieves:
- Improved pulmonary function
- Reduced need for rescue medications
- Decreased asthma symptoms
- Reduced risk of exacerbations 4
Potential Adverse Effects
Local Effects
- Dysphonia (hoarseness)
- Oral candidiasis (thrush)
- Cough
- Throat irritation 5
Systemic Effects (rare with recommended doses)
- Potential growth suppression in children (transient)
- Adrenal suppression (with high doses)
- Skin thinning and bruising (with prolonged high-dose use) 5
Monitoring and Follow-up
- Monitor response to therapy based on symptom control and lung function
- Increased need for rescue bronchodilators indicates inadequate control and need for controller medication adjustment 5
- Regularly reassess to determine the minimum effective dose
Practical Considerations
- Patients often prefer dry powder inhalers (like Turbuhaler) over MDIs due to ease of use 6
- When using the MDI, proper inhalation technique is essential for optimal drug delivery
- Clean the MDI actuator periodically as drug may plug the orifice 1
Drug Interactions
- Potent CYP3A4 inhibitors (e.g., ritonavir, ketoconazole) can increase systemic concentrations of budesonide 5
- Can be safely used with short-acting beta-agonists in the same treatment session
Budesonide MDI is an effective controller medication for persistent asthma when used at appropriate doses with proper technique. Regular monitoring and dose adjustment are essential for optimal outcomes.