Recommended Dosage of Formoterol/Budesonide for Asthma and COPD
For adults with asthma, the standard maintenance dose of budesonide/formoterol is 2 inhalations twice daily of either 80/4.5 mcg (160/9 mcg total) or 160/4.5 mcg (320/9 mcg total) strength, with selection based on asthma severity. 1
Asthma Dosing Guidelines
Adult Dosing
- Mild-to-moderate persistent asthma: Budesonide/formoterol 80/4.5 mcg, 2 inhalations twice daily (160/9 mcg total daily dose)
- Moderate-to-severe persistent asthma: Budesonide/formoterol 160/4.5 mcg, 2 inhalations twice daily (320/9 mcg total daily dose) 1, 2
- Maximum daily dose: Up to 12 total inhalations in any single day (not to exceed 4 inhalations at once) 1
Budesonide Component Dosing
- Low daily dose: 180-400 mcg for children 5-11 years; 600 mcg for adults
- Medium daily dose: >400-800 mcg for children 5-11 years; >600-1200 mcg for adults
- High daily dose: >800 mcg for children 5-11 years; >1200 mcg for adults 3
COPD Dosing Guidelines
For patients with moderate to very severe COPD:
- Budesonide/formoterol 160/4.5 mcg, 2 inhalations twice daily (320/9 mcg total daily dose) 4, 5
- This dosage has been shown to reduce exacerbations by 24% versus placebo and 23% versus formoterol alone 5
Therapeutic Considerations
Efficacy Evidence
- Budesonide/formoterol combination is more effective than equivalent or higher doses of budesonide alone for improving peak expiratory flow, symptom control, and reducing exacerbations 6
- The FACET study demonstrated that formoterol (24 mcg daily) combined with budesonide (either 200 or 800 mcg daily) reduced mild and severe exacerbations by 40% and 29% respectively 3
- Budesonide/formoterol has shown a rapid onset of bronchodilation (within 15 minutes), which is faster than some other combination inhalers 2
Safety Considerations
- Formoterol should never be used as monotherapy for asthma due to increased risk of asthma-related death 1
- The maximum daily dose should not exceed 12 total inhalations for adults and adolescents (≥12 years) 1
- Patients should be instructed to rinse their mouth after use to prevent localized Candida infections 1
- High-dose budesonide/formoterol (320/9 mcg, two inhalations twice daily) has been shown to be well-tolerated with a safety profile comparable to its monocomponents 7
Patient Monitoring and Adjustment
- Increased use of rescue medication (more than twice weekly) generally indicates inadequate control and may require adjustment of therapy 1
- For patients using budesonide/formoterol as both maintenance and reliever therapy, clear instructions should be provided for increasing use during worsening symptoms 1
- Regular assessment of asthma control is essential to determine if dosage adjustments are needed 1
Special Populations
- For children under 12 years, consult specific pediatric guidelines as evidence is more limited
- Budesonide/formoterol is not recommended for children under 6 years of age 1
The combination of budesonide and formoterol in a single inhaler simplifies asthma management and may improve compliance compared to using separate inhalers 6.