Dosage of Pulmicort (Budesonide) Inhalation for Elderly Patients with Influenza A and COVID-19
For elderly patients with influenza A and COVID-19, the recommended dosage of Pulmicort (budesonide) inhalation is 400 μg (two inhalations of 200 μg) twice daily for 14 days. This dosage has shown effectiveness in reducing COVID-19 symptom duration and preventing clinical deterioration 1, 2.
Rationale for Budesonide Use in COVID-19 and Influenza
Inhaled budesonide has demonstrated significant benefits in the treatment of COVID-19:
- Reduces the likelihood of needing urgent medical care by approximately 90% 1
- Shortens time to recovery by approximately 1 day (7 days vs 8 days) 1
- Decreases persistent symptoms at days 14 and 28 1
- Particularly beneficial for high-risk individuals, including elderly patients 2
Dosing Protocol
- Initial dose: 400 μg twice daily (morning and evening)
- Administration method: Two inhalations of 200 μg per actuation using a Turbuhaler device
- Duration: Continue for 14 days or until symptom resolution 1
- Timing: Take at consistent times each day, approximately 12 hours apart
Special Considerations for Elderly Patients
- No dosage adjustment is required based on age alone 3
- Monitor for potential side effects, which are generally mild and include:
- Dysphonia (voice changes)
- Oral candidiasis
- Potential for increased risk of pneumonia in COPD patients
Concurrent Management of Influenza A
For the influenza component, consider adding:
- Oseltamivir: 75 mg twice daily for 5 days if within 48 hours of symptom onset 4
Monitoring Recommendations
Monitor the following parameters at least twice daily 4:
- Temperature (fever >37.8°C)
- Heart rate (>100/min indicates deterioration)
- Respiratory rate (>24/min indicates deterioration)
- Blood pressure (systolic <90 mmHg indicates deterioration)
- Oxygen saturation (<90% indicates deterioration)
- Mental status
Evidence Quality and Limitations
The recommendation for budesonide is based on two high-quality randomized controlled trials:
The STOIC trial 1 demonstrated that inhaled budesonide 400 μg twice daily reduced COVID-19-related urgent care visits or hospitalizations (1% vs 14% in control group).
The PRINCIPLE trial 2, a larger adaptive platform trial, showed improved time to recovery and potential reduction in hospitalizations with the same dosage.
Common Pitfalls to Avoid
- Do not use budesonide as a substitute for other necessary COVID-19 or influenza treatments
- Do not discontinue prematurely once symptoms begin to improve
- Ensure proper inhaler technique for optimal drug delivery
- Rinse mouth after each use to prevent oral candidiasis
- Monitor for potential worsening of symptoms despite treatment, which may indicate bacterial superinfection requiring antibiotics
For patients experiencing difficulty with the Turbuhaler device, a spacer device can be considered, though the Turbuhaler generally achieves better lung deposition than metered-dose inhalers 5.