Foracort 200 MDI (Budesonide/Formoterol) Dosing in Children Above 6 Years with Asthma Exacerbation
Foracort 200 MDI (budesonide/formoterol) should not be given at a dosage of 2 puffs every 6 hours in children above 6 years with asthma exacerbation, as this combination medication is intended for maintenance therapy and not for frequent reliever use during exacerbations. 1
Appropriate Management of Asthma Exacerbations in Children
Quick-Relief Medications for Exacerbations
- Short-acting beta2-agonists (SABAs) like albuterol are the treatment of choice for relief of acute asthma symptoms and exacerbations 1
- For children 5-11 years with exacerbations, albuterol MDI should be given as 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- Increasing use of SABA treatment or using SABA >2 days a week for symptom relief generally indicates inadequate asthma control and the need for initiating or intensifying anti-inflammatory therapy 1
Role of Budesonide/Formoterol in Asthma Management
- Budesonide/formoterol contains a long-acting beta2-agonist (formoterol) and an inhaled corticosteroid (budesonide), which are primarily intended for maintenance therapy 1
- Long-acting beta2-agonists (LABAs) like formoterol are not to be used as monotherapy for acute symptom relief during exacerbations 1
- LABAs are used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma 1
Proper Management of Exacerbations in Children
Immediate Treatment Approach
- For moderate to severe exacerbations in children, the recommended approach is:
- SABA (albuterol) via MDI with spacer: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- For severe exacerbations: Consider systemic corticosteroids (1-2 mg/kg/day of prednisone or equivalent, maximum 60 mg/day) for 3-10 days 1
- Ipratropium bromide may be added for severe exacerbations 1
Monitoring and Follow-up
- Monitor response to therapy closely, especially in young children 1
- If a clear beneficial response is not observed within 4-6 weeks of initiating controller therapy, treatment should be reassessed 1
- Once control of asthma symptoms is established, a careful step down in therapy should be attempted 1
Important Considerations and Pitfalls
Common Pitfalls to Avoid
- Using combination ICS/LABA products (like Foracort) as rescue medication instead of SABAs during exacerbations 1
- Overreliance on nebulizers when MDIs with spacers can be equally effective with proper technique 1
- Failure to provide systemic corticosteroids early in moderate to severe exacerbations 1
Special Considerations for Children
- Children <4 years generally require delivery of inhaled medications through a face mask that should fit snugly over nose and mouth 1
- Most children cannot achieve the coordination necessary to use an unmodified MDI; spacers or valved holding chambers should be used 1
- Ensure proper inhaler technique and appropriate device selection based on the child's age 1
Conclusion for Clinical Practice
- For asthma exacerbations in children above 6 years, use albuterol MDI with spacer (4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed) 1
- Reserve Foracort 200 (budesonide/formoterol) for maintenance therapy in moderate to severe persistent asthma, not for frequent dosing during exacerbations 1
- Consider systemic corticosteroids for moderate to severe exacerbations 1
- Ensure proper education on medication use, inhaler technique, and written action plan for exacerbations 1