What is the recommended dose of Budecort (budesonide) for a 3-year-old child?

Budesonide Dosing for a 3-Year-Old Child

For a 3-year-old child, the recommended dose of Budecort (budesonide) nebulization suspension is 0.25-0.5 mg twice daily for low-dose therapy, and >0.5-1.0 mg twice daily for medium-dose therapy. 1

Dosing Guidelines

• Budesonide nebulizer suspension is the only inhaled corticosteroid (ICS) with FDA-approved labeling for children under 4 years of age 2, 1
• For children 0-4 years of age, the recommended dosing is:
  • Low-dose therapy: 0.25-0.5 mg twice daily 1
  • Medium-dose therapy: >0.5-1.0 mg twice daily 1
• The dose should be administered twice daily for optimal efficacy 1
• Once asthma control is achieved, the dose should be carefully titrated to the minimum dose required to maintain control 1

Administration Considerations

• For children under 4 years of age, budesonide should be delivered through a face mask that fits snugly over the nose and mouth 2, 1
• Avoid nebulizing in the eyes to prevent local irritation 1
• Wash the child's face after each treatment to prevent local side effects 2, 1
• Use only jet nebulizers for budesonide suspension, as ultrasonic nebulizers are ineffective for suspensions 2
• Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 2, 1

Efficacy and Safety

• Studies have demonstrated that budesonide inhalation suspension is effective and safe for young children with persistent asthma 3, 4
• All doses of budesonide inhalation suspension (0.25 mg, 0.50 mg, and 1.0 mg twice daily) have shown efficacy in improving asthma symptoms in young children 3
• Once-daily dosing has also shown efficacy in mild persistent asthma, but twice-daily dosing is generally recommended 4
• High-dose nebulized budesonide (1 mg twice daily) has been shown to be effective for mild asthma exacerbations in children under 3 years of age 5

Potential Adverse Effects

• Common side effects include cough, dysphonia, and oral thrush (candidiasis) 2, 1
• Using a face mask and washing the face after treatment can help decrease local side effects 1
• In low-to-medium doses, suppression of growth velocity has been observed in children, but this effect may be transient 2, 1
• Studies have shown that 12-month administration of inhaled budesonide to preschool-age children is safe with no significant effects on height, weight, bone age, or adrenal function 6

Clinical Decision Making

• The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy 2, 1
• Start with low-dose therapy (0.25-0.5 mg twice daily) for mild persistent asthma 1
• Consider medium-dose therapy (>0.5-1.0 mg twice daily) for more severe symptoms or inadequate response to low-dose therapy 1
• Monitor the child's response on several clinical parameters and adjust the dose accordingly 2
• Once control is achieved, gradually titrate to the minimum effective dose 1