Indications for Budesonide Nebulisation in Children
Budesonide nebulisation in children is primarily indicated for maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age, and is not indicated for the relief of acute bronchospasm. 1
Primary Indications
- Maintenance treatment of persistent asthma in children 12 months to 8 years of age 1
- Prophylactic therapy for persistent asthma in children 12 months to 8 years of age 1
- Croup: Nebulised budesonide (500 μg) may reduce symptoms in croup in the first two hours 2
- Bronchopulmonary dysplasia (BPD): Uncontrolled data suggest inhaled steroids may improve lung mechanics and short-term outcomes in neonates 2
Dosing Recommendations
For children with persistent asthma (12 months to 8 years): 1
- Starting with bronchodilators alone: 0.5 mg once daily or 0.25 mg twice daily
- Previous inhaled corticosteroids: 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily
- Previous oral corticosteroids: 0.5 mg twice daily
- In symptomatic children not responding to non-steroidal therapy: 0.25 mg once daily may be considered
For viral-induced wheeze in children under 4 years: 3
- Maintenance therapy: 0.25-0.5 mg twice daily
- Intermittent therapy at onset of respiratory infection: 1 mg twice daily for 7 days
For croup: 500 μg as a single dose or repeated dose 2
Administration Considerations
- Budesonide inhalation suspension should be administered via compressed air-driven jet nebulizers only (not for use with ultrasonic devices) 1
- For children under 4 years, delivery requires a face mask that should fit snugly over nose and mouth 4
- Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 4
- Patients should rinse their mouth after treatment to prevent oral candidiasis 1
Important Limitations
- Not indicated for relief of acute bronchospasm or management of status asthmaticus 1
- For acute asthma exacerbations, short-acting beta2-agonists like albuterol are the treatment of choice 5
- The safety and efficacy in children under 12 months has not been fully established 1
Clinical Evidence and Efficacy
- Studies have shown that once-daily budesonide inhalation suspension (0.25 mg, 0.5 mg, or 1.0 mg) is effective for the treatment of mild persistent asthma in infants and young children 6
- High-dose nebulized budesonide (1 mg twice daily) has been shown to be as effective as systemic steroids for mild asthma exacerbations in children under 3 years of age 7
- Budesonide inhalation suspension has demonstrated improvements in pulmonary function and reduction in asthma symptoms in infants and young children with persistent asthma 8
Safety Considerations
- Common adverse reactions include respiratory infection, rhinitis, coughing, otitis media, viral infection, moniliasis, and gastroenteritis 1
- Potential local side effects include candidiasis of the mouth and throat, which can be minimized by rinsing the mouth after use 1
- Monitor growth in pediatric patients as inhaled corticosteroids may affect growth velocity 1
- In studies, budesonide inhalation suspension at recommended doses did not cause clinically significant effects on hypothalamic-pituitary-adrenal axis function 9
Clinical Approach to Therapy
- Assess asthma severity and control before initiating therapy 5
- Start with the lowest recommended dose and titrate based on clinical response 1
- Once asthma stability is achieved, titrate the dose downwards 1
- If no clear benefit is observed within 4-6 weeks, consider alternative therapies or diagnoses 4
- For recurrent wheezing triggered by respiratory infections, consider intermittent high-dose therapy 3
Budesonide nebulization represents an important therapeutic option for young children with asthma who cannot effectively use other inhaler devices, offering both maintenance treatment and prophylactic benefits for persistent asthma.