Can budesonide be mixed with normal saline (0.9% sodium chloride solution) for nebulization?

Budesonide Compatibility with Normal Saline for Nebulization

Yes, budesonide can be mixed with normal saline (0.9% sodium chloride solution) for nebulization. According to guidelines, normal saline is an appropriate diluent for nebulized medications including budesonide.

Compatibility and Administration Guidelines

• Budesonide inhalation suspension should be administered with a jet nebulizer connected to a compressor with adequate air flow, equipped with a mouthpiece or suitable face mask 1
• Normal saline (0.9% sodium chloride) is an appropriate solution for nebulization, unlike water which should not be used as it may cause bronchoconstriction 2
• The British Thoracic Society specifically mentions that normal saline may be used in nebulization to loosen tenacious secretions 2
• For children under 4 years, budesonide suspension is the only inhaled corticosteroid with FDA-approved labeling 3

Important Administration Considerations

• Only jet nebulizers should be used for budesonide suspension, as ultrasonic nebulizers are ineffective for suspensions 3, 1
• When administering budesonide:
  • The typical volume of fluid in the nebulizer chamber is usually 2.0-5.0 ml 2
  • For children under 4 years, delivery requires a face mask that should fit snugly over nose and mouth 3
  • Face should be washed after treatment to prevent local side effects such as oral candidiasis 3, 1

Medication-Specific Guidance

• Budesonide is compatible with albuterol (salbutamol), ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 3
• The FDA label notes that "the effects of mixing budesonide inhalation suspension with other nebulizable medications have not been adequately assessed" but does not contraindicate mixing with normal saline 1
• Clinical studies have demonstrated the efficacy of budesonide inhalation suspension in treating various respiratory conditions when properly administered 4, 5

Clinical Considerations

• Normal saline is preferred over hypertonic saline in most routine nebulization cases, though 3% saline may be more effective in specific conditions like bronchiolitis 6
• Budesonide is not meant to relieve acute asthma symptoms; it should be used as prescribed for anti-inflammatory effects in persistent asthma 1, 4
• When administering nebulized corticosteroids like budesonide, a mouthpiece should be used (rather than a mask) to prevent deposition on the face when possible 2

Potential Adverse Effects

• Local side effects of nebulized budesonide may include cough, dysphonia, and oral candidiasis 3, 1
• Rinsing the mouth after inhalation is advised to reduce the risk of oropharyngeal candidiasis 1

Remember that budesonide is a corticosteroid intended for anti-inflammatory effects and is not a rescue medication for acute symptoms 1, 4.