Can inhaled salbutamol (albuterol) be used in infants less than 1 year with wheezing along with budesonide?

Use of Salbutamol with Budesonide in Infants Under 1 Year with Wheezing

Yes, inhaled salbutamol (albuterol) can be used alongside budesonide in infants less than 1 year of age with wheezing, as budesonide nebulizer suspension is specifically noted to be compatible with albuterol in the same nebulizer. 1

Evidence Supporting Combined Use

• Budesonide suspension is explicitly stated to be compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1
• For infants with acute wheezing, nebulized budesonide has been shown to be effective when used alongside standard treatment regimens that include bronchodilators 2
• Guidelines specifically mention that budesonide is the only inhaled corticosteroid (ICS) with FDA-approved labeling for children under 4 years of age 1

Dosing Considerations

• For infants under 1 year with wheezing:

  • Albuterol (salbutamol) nebulizer solution: 0.63 mg/3 mL 1
  • Budesonide nebulizer suspension: 0.25-0.5 mg (low daily dose) 1

• The budesonide dose may be administered twice daily and can be increased to >0.5-1.0 mg for medium daily dosing if needed 1

Administration Technique

• For children under 4 years of age:
  • Delivery requires a face mask that should fit snugly over nose and mouth 1
  • Avoid nebulizing in the eyes 1
  • Wash face after each treatment to prevent local side effects 1
  • Use only jet nebulizers because ultrasonic nebulizers are ineffective for suspensions 1

Efficacy in Infants

• Studies have shown that budesonide is effective in controlling chest symptoms in infants as young as 3 months 3, 4
• When combined with standard treatments including bronchodilators, budesonide has been associated with faster clinical improvement and reduced hospital stays in infants with acute wheezing 2
• Budesonide inhalation suspension has demonstrated effectiveness in reducing day and night-time symptom scores and decreasing the need for rescue bronchodilators in infants with persistent asthma 5

Safety Considerations

• The safety and efficacy of inhaled corticosteroids in children under 1 year has not been fully established, requiring careful monitoring 1
• Potential local side effects include cough, dysphonia, and oral thrush (candidiasis) 1
• Long-term studies in young children have shown that budesonide at appropriate doses does not significantly affect growth velocity or adrenal function 5, 4
• Monitor for potential adverse effects, though the frequency of adverse events in clinical trials was similar between budesonide and placebo in 12-week studies 5

Clinical Approach

1. Assess severity of wheezing and respiratory distress

2. For acute wheezing episodes:

   • Start with salbutamol (albuterol) nebulization 1
   • Add budesonide if symptoms persist or are moderate to severe 6, 2

3. For recurrent or persistent wheezing:

   • Consider regular budesonide treatment alongside as-needed salbutamol 1
   • Monitor response carefully; if no clear benefit is observed within 4-6 weeks, consider alternative therapies or diagnoses 1

4. Step down therapy once control is achieved and sustained 1

Remember that the therapeutic approach should be guided by the severity of symptoms and response to treatment, with careful monitoring for both efficacy and adverse effects.