Budesonide Nebulization Dosing in Pediatric Patients
For pediatric patients, budesonide inhaled suspension for nebulization should be dosed at 0.25-0.5 mg twice daily for children 0-4 years of age for low-dose therapy, and >0.5-1.0 mg twice daily for medium-dose therapy. 1
Age-Specific Dosing Recommendations
Children 0-4 years of age:
- Low daily dose: 0.25-0.5 mg 1
- Medium daily dose: >0.5-1.0 mg 1
- High daily dose: Not established for this age group 1
- Budesonide nebulizer suspension is the only inhaled corticosteroid with FDA-approved labeling for children <4 years of age 1
Children 5-11 years of age:
- Budesonide inhaled suspension is not specifically indicated in this age group according to dosing tables, as other delivery methods are typically used 1
Administration considerations:
- For children <4 years of age: Use a face mask that fits snugly over nose and mouth 1
- Avoid nebulizing in the eyes 1
- Wash face after each treatment to prevent local side effects 1
- The dose may be administered twice daily 1, 2
- Use only jet nebulizers because ultrasonic nebulizers are ineffective for suspensions 1, 2
Clinical Evidence and Efficacy
- Clinical trials have demonstrated that budesonide inhalation suspension at doses of 0.25 mg, 0.5 mg, and 1.0 mg twice daily is effective and safe for treating persistent asthma in young children 3
- Studies show that budesonide inhalation suspension improves nighttime and daytime asthma symptom scores, reduces use of rescue medication, and improves morning peak expiratory flow 2, 3
- Both once-daily and twice-daily dosing regimens have shown efficacy, though evidence is stronger for twice-daily dosing 2, 4
Practical Administration Tips
- Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1
- Gently shake the ampule using a circular motion before use 2
- After opening the aluminum foil envelope, the shelf life of unused ampules is 2 weeks when protected from light 2
- The safety and efficacy of inhaled corticosteroids in children <1 year has not been established 1
Potential Adverse Effects
- Common side effects include cough, dysphonia, and oral thrush (candidiasis) 1
- In high doses, systemic effects may occur, though studies are not conclusive 1
- In low-to-medium doses, suppression of growth velocity has been observed in children, but this effect may be transient 1
Clinical Pearls and Caveats
- The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy 1
- Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 1
- Budesonide has a high ratio of topical anti-inflammatory to systemic activity, making it suitable for pediatric use 5
- Total systemic availability of budesonide after dosing with a jet nebulizer in children 3-6 years of age is approximately 6% of the labeled dose 5